pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	pbp_a_platino_flag	pbp_a_contract_partd_flag	pbp_a_last_data_entry_date	pbpver	pbp_a_ready_for_upload_date_tm	pbp_a_BPT_MA_date_time	pbp_a_BPT_PD_date_time	pbp_a_BPT_MSA_date_time	pbp_a_BPT_ESRD_date_time	pbp_a_upload_date_time	pbp_a_org_name	pbp_a_org_marketing_name	pbp_a_org_website	pbp_a_plan_name	pbp_a_org_type	pbp_a_plan_type	pbp_a_network_flag	pbp_a_ben_cov	pbp_a_hospice_care_yn	pbp_a_service_area	pbp_a_contract_number	pbp_a_plan_identifier	pbp_a_segment_id	pbp_a_contract_period	pbp_a_plan_geog_name	pbp_a_segment_name	pbp_a_eghp_yn	pbp_a_est_memb	pbp_a_continue_yn	pbp_a_continue_costshare_yn	pbp_a_platino_yn	pbp_a_special_need_flag	pbp_a_special_need_plan_type	pbp_a_snp_institutional_type	pbp_a_snp_pct	pbp_a_snp_pop	pbp_a_snp_cond	pbp_a_snp_state_cvg_yn	pbp_a_opd_web_addr	pbp_a_formulary_web_addr	pbp_a_pharmacy_website	pbp_a_curmbr_phone	pbp_a_curmbr_phone_ext	pbp_a_curmbr_loc_phone	pbp_a_curmbr_loc_phone_ext	pbp_a_prombr_phone	pbp_a_prombr_phone_ext	pbp_a_prombr_loc_phone	pbp_a_prombr_loc_phone_ext	pbp_a_pd_curmbr_phone	pbp_a_pd_curmbr_phone_ext	pbp_a_pd_curmbr_loc_phone	pbp_a_pd_curmbr_loc_phone_ext	pbp_a_pd_prombr_phone	pbp_a_pd_prombr_phone_ext	pbp_a_pd_prombr_loc_phone	pbp_a_pd_prombr_loc_phone_ext	pbp_a_ttytdd_curmbr_phone	pbp_a_ttytdd_curmbr_phone_ext	pbp_a_ttytdd_cur_loc_phone	pbp_a_ttytdd_cur_loc_phone_ext	pbp_a_ttytdd_prombr_phone	pbp_a_ttytdd_prombr_phone_ext	pbp_a_ttytdd_pro_loc_phone	pbp_a_ttytdd_pro_loc_phone_ext	pbp_a_pd_ttytdd_curmbr_phone	pbp_a_pd_ttytdd_curmbr_phn_ext	pbp_a_pd_ttytdd_cur_loc_phone	pbp_a_pd_ttytdd_cur_loc_phn_ex	pbp_a_pd_ttytdd_prombr_phone	pbp_a_pd_ttytdd_prombr_phn_ext	pbp_a_pd_ttytdd_pro_loc_phone	pbp_a_pd_ttytdd_pro_loc_phn_ex	pbp_a_ffs_bid_b_yn	pbp_a_ffs_bid_b_auth_yn	pbp_a_ffs_bid_b_auth_cats	pbp_a_ffs_bid_b_ref_yn	pbp_a_ffs_bid_b_ref_cats	pbp_a_ffs_bid_c_yn	pbp_a_ffs_bid_c_auth_yn	pbp_a_ffs_bid_c_auth_cats	pbp_a_ffs_bid_c_ref_yn	pbp_a_ffs_bid_c_ref_cats	pbp_a_ffs_bid_d_yn
E0654	801	0		30	13	E0654_801_0	1		1	06/02/2014	2015.01	06/02/2014 06:01:51 PM Eastern Daylight Time					06/02/2014 06:05:08 PM Eastern Daylight Time	IBT VOLUNTARY EMPLOYEE BENEFITS TRUST	TEAMStar Medicare Part D Prescription Drug Program	www.teamstarpartd.com	IBT Voluntary Employee Benefits Trust (Employer PDP)	13	30					E0654	801	0	2015	National		1					2								http://www.rxsolutions.com/pdpclientformulary/formulary.asp?var=IBTPDPGOLD&infoid=IBT	www.rxsolutions.com									(866)524-4173		(866)524-4173		(866)524-4173		(866)524-4173										(866)524-4174		(866)524-4174		(866)524-4174		(866)524-4174												
E0654	802	0		30	13	E0654_802_0	2		1	06/02/2014	2015.01	06/02/2014 06:02:15 PM Eastern Daylight Time					06/02/2014 06:08:40 PM Eastern Daylight Time	IBT VOLUNTARY EMPLOYEE BENEFITS TRUST	TEAMStar Medicare Part D Prescription Drug Program	www.teamstarpartd.com	IBT Voluntary Employee Benefit Fund 802 (Employer PDP)	13	30					E0654	802	0	2015	IBT Voluntary Employee Benefit Fund 802		1					2								http://www.rxsolutions.com/pdpclientformulary/formulary.asp?var=IBTPDPGOLD&infoid=IBT	www.rxsolutions.com									(866)524-4173		(866)524-4173		(866)524-4173		(866)524-4173										(866)524-4174		(866)524-4174		(866)524-4174		(866)524-4174												
E0654	803	0		30	13	E0654_803_0	2		1	06/02/2014	2015.01	06/02/2014 06:02:30 PM Eastern Daylight Time					06/02/2014 06:08:40 PM Eastern Daylight Time	IBT VOLUNTARY EMPLOYEE BENEFITS TRUST	TEAMStar Medicare Part D Prescription Drug Program	www.teamstarpartd.com	IBT Voluntary Employee Benefit Fund 803 (Employer PDP)	13	30					E0654	803	0	2015	IBT Voluntary Employee Benefit Fund 803		1					2								http://www.rxsolutions.com/pdpclientformulary/formulary.asp?var=IBTPDPGOLD&infoid=IBT	www.rxsolutions.com									(866)524-4173		(866)524-4173		(866)524-4173		(866)524-4173										(866)524-4174		(866)524-4174		(866)524-4174		(866)524-4174												
E2630	801	0		30	13	E2630_801_0	1		1	05/19/2014	2015.01	05/19/2014 12:01:03 PM Eastern Daylight Time					05/19/2014 12:01:11 PM Eastern Daylight Time	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	C and O Employees Hospital Association	www.coeha.com	C and O Employees Hospital Association (Employer PDP)	13	30					E2630	801	0	2015	Virginia, West VA, Kentucky, Ohio, Indiana		1					2								http://www.coeha.com	http://www.navitus.com									(800)679-9135		(540)862-5728		(800)679-9135		(540)862-5728										(711)000-0000		(711)000-0000		(711)000-0000		(711)000-0000												
E3014	801	0		30	13	E3014_801_0	1		1	05/29/2014	2015.01	05/29/2014 05:06:41 PM Eastern Daylight Time					05/30/2014 10:35:36 PM Eastern Daylight Time	PSERS HOP PROGRAM	Pennsylvania Public School Employees Retirement Sy	http://www.psers.state.pa.us/hop/hop.htm	PSERS HOP (Employer PDP)	13	30					E3014	801	0	2015	National		1					2								http://www.hopbenefits.com/medicareRx/drugData/	http://www.hopbenefits.com/medicareRx/index.cfm?fa=findPharmacy									(888)239-1301		(888)239-1301		(800)773-7725		(800)773-7725										(800)498-5428		(800)498-5428		(800)498-5428		(800)498-5428												
E4744	801	0		30	13	E4744_801_0	1		1	06/03/2014	2015.01	06/03/2014 02:30:00 PM Eastern Daylight Time					06/03/2014 02:30:34 PM Eastern Daylight Time	MODOT/MSHP MEDICAL AND LIFE INSURANCE PLAN	MISSOURI DEPARTMENT OF TRANSPORTATION	http://www.modot.state.mo.us/	Missouri Department of Transportaion/ Highway Patr (Employer PDP)	13	30					E4744	801	0	2015	National		1					2								http://www.CatamaranRx.com/	http://www.CatamaranRx.com/									(877)235-1981		(573)751-2551		(800)601-3002		(573)751-2551										(888)206-8041		(888)206-8041		(800)221-6915		(800)221-6915												
E7316	801	0		30	13	E7316_801_0	1		1	05/29/2014	2015.01	05/29/2014 05:07:02 PM Eastern Daylight Time					05/30/2014 02:25:43 PM Eastern Daylight Time	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	Union Pacific Railroad  Employes Health Systems	www.uphealth.com	The UPREHS Prime Medicare Plan (Employer PDP)	13	30					E7316	801	0	2015	National Including Puerto Rico		1					2								www.uphealth.com	www.uphealth.com									(800)547-0421		(801)595-4300		(800)547-0421		(801)595-4300										(711)000-0000		(711)000-0000		(711)000-0000		(711)000-0000												
E7848	801	0		30	13	E7848_801_0	1		1	05/27/2014	2015.01	05/27/2014 09:55:29 AM Central Daylight Time					05/27/2014 09:55:43 AM Central Daylight Time	OMES EMPLOYEES GROUP INSURANCE DIVISION	HealthChoice	www.sib.ok.gov	OMES Employees Group Insurance Division (Employer PDP)	13	30					E7848	801	0	2015	State of Oklahoma		1					2								www.ok.gov/sib	www.ok.gov/sib									(800)865-5142		(405)717-8699		(800)865-5142		(405)717-8699										(866)447-0436		(405)949-2281		(866)447-0436		(405)949-2281												
H0022	001	0	1	48	05	H0022_001_0	4		1	08/19/2014	2015.01	08/19/2014 07:58:39 PM Central Daylight Time					08/19/2014 08:19:16 PM Central Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Buckeye Health Plan	www.bchpohio.com	Buckeye Health Plan - MyCareOhio (Medicare-Medicaid Plan)	05	48		1			H0022	001	0	2015	Cleveland, Dayton, Toledo and surrounding counties		2	12000	2			2							www.bchpohio.com	www.bchpohio.com	www.bchpohio.com	(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(866)549-8289		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H0028	001	0	1	01	01	H0028_001_0	3		1	08/02/2014	2015.02	08/02/2014 09:00:21 AM Eastern Daylight Time	08/02/2014 12:26:32 PM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Gold Plus H0028-001 (HMO)	01	01		1			H0028	001	0	2015	Johnson and Linn counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0028	002	0	1	01	01	H0028_002_0	3		1	08/02/2014	2015.02	08/02/2014 09:02:13 AM Eastern Daylight Time	08/02/2014 12:38:11 PM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Gold Plus H0028-002 (HMO)	01	01		1			H0028	002	0	2015	Des Moines Metro area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0028	003	0	1	01	01	H0028_003_0	3		1	08/02/2014	2015.02	08/02/2014 09:03:46 AM Eastern Daylight Time	08/02/2014 12:33:15 PM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Gold Plus H0028-003 (HMO)	01	01		1			H0028	003	0	2015	Pottawattamie County		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0028	004	0	1	01	01	H0028_004_0	3		1	08/01/2014	2015.02	08/01/2014 07:37:54 PM Eastern Daylight Time	08/04/2014 05:11:22 PM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Gold Plus H0028-004 (HMO)	01	01		1			H0028	004	0	2015	Honolulu, Kauai and Maui counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0028	801	0	1	01	01	H0028_801_0	3		1	05/23/2014	2015.02	05/23/2014 11:21:41 AM Eastern Daylight Time	07/14/2014 11:06:59 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H0028	801	0	2015	Select Counties in Iowa and Hawaii		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0028	802	0	1	01	01	H0028_802_0	2		1	05/23/2014	2015.02	05/23/2014 10:58:32 AM Eastern Daylight Time	07/14/2014 11:07:40 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	CHA HMO, INC.	CHA HMO, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H0028	802	0	2015	Select Counties in Iowa and Hawaii		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0084	001	0	1	04	01	H0084_001_0	4		1	07/16/2014	2015.02	07/16/2014 03:30:11 PM Central Daylight Time	08/04/2014 02:17:34 PM Central Daylight Time	07/31/2014 03:17:58 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H0084	001	0	2015	Various counties in IL, IN, IA, NE, NM, NC, TX		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0084	004	0	1	04	01	H0084_004_0	4		1	07/16/2014	2015.02	07/16/2014 03:30:25 PM Central Daylight Time	08/04/2014 03:59:02 PM Central Daylight Time	07/31/2014 03:18:07 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H0084	004	0	2015	Various counties in IL, IN, IA, NE, NM, NC, TX		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0084	014	0	1	04	01	H0084_014_0	3		1	05/29/2014	2015.02	05/29/2014 04:37:52 PM Central Daylight Time	08/04/2014 03:59:19 PM Central Daylight Time	07/31/2014 03:18:17 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (PPO SNP)	01	04		1			H0084	014	0	2015	Various counties in Indiana, Iowa		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	010	1	1	04	01	H0104_010_1	4		1	07/21/2014	2015.01	07/21/2014 12:26:18 PM Central Daylight Time	08/04/2014 03:14:04 PM Central Daylight Time	08/04/2014 03:14:04 PM Central Daylight Time			08/06/2014 10:49:03 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	010	1	2015	H0104 Plan 010 Areas 1 through 5	Limited to certain counties	2	1269	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	010	2	1	04	01	H0104_010_2	4		1	07/21/2014	2015.01	07/21/2014 12:22:46 PM Central Daylight Time	08/04/2014 03:14:20 PM Central Daylight Time	08/04/2014 03:14:12 PM Central Daylight Time			08/06/2014 10:49:03 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	010	2	2015	H0104 Plan 010 Areas 1 through 5	Limited to certain counties	2	157	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	010	3	1	04	01	H0104_010_3	4		1	07/21/2014	2015.01	07/21/2014 12:22:58 PM Central Daylight Time	08/04/2014 03:14:32 PM Central Daylight Time	08/04/2014 03:14:32 PM Central Daylight Time			08/06/2014 10:49:03 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	010	3	2015	H0104 Plan 010 Areas 1 through 5	Limited to certain counties	2	373	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	010	4	1	04	01	H0104_010_4	4		1	07/21/2014	2015.01	07/21/2014 12:23:11 PM Central Daylight Time	08/04/2014 03:14:40 PM Central Daylight Time	08/04/2014 03:14:40 PM Central Daylight Time			08/06/2014 10:49:03 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	010	4	2015	H0104 Plan 010 Areas 1 through 5	Limited to certain counties	2	3617	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	010	5	1	04	01	H0104_010_5	4		1	07/21/2014	2015.01	07/21/2014 12:23:25 PM Central Daylight Time	08/04/2014 03:14:46 PM Central Daylight Time	08/04/2014 03:14:46 PM Central Daylight Time			08/06/2014 10:49:03 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Premier (PPO)	01	04		1			H0104	010	5	2015	H0104 Plan 010 Areas 1 through 5	Limited to certain counties	2	1327	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	011	1	1	04	01	H0104_011_1	10		1	07/21/2014	2015.01	07/21/2014 01:58:33 PM Central Daylight Time	08/04/2014 03:14:54 PM Central Daylight Time	08/04/2014 03:14:54 PM Central Daylight Time			08/06/2014 10:29:17 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	011	1	2015	H0104 Plan 011 Areas 1 through 6	State of Alabama	2	161	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	011	2	1	04	01	H0104_011_2	8		1	07/21/2014	2015.01	07/21/2014 01:58:49 PM Central Daylight Time	08/04/2014 03:15:00 PM Central Daylight Time	08/04/2014 03:15:00 PM Central Daylight Time			08/06/2014 10:29:17 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	011	2	2015	H0104 Plan 011 Areas 1 through 6	State of Alabama	2	954	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	011	3	1	04	01	H0104_011_3	8		1	07/21/2014	2015.01	07/21/2014 02:39:37 PM Central Daylight Time	08/04/2014 03:15:06 PM Central Daylight Time	08/04/2014 03:15:06 PM Central Daylight Time			08/06/2014 10:29:17 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	011	3	2015	H0104 Plan 011 Areas 1 through 6	State of Alabama	2	13525	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	011	4	1	04	01	H0104_011_4	8		1	07/21/2014	2015.01	07/21/2014 01:59:19 PM Central Daylight Time	08/04/2014 03:15:12 PM Central Daylight Time	08/04/2014 03:15:12 PM Central Daylight Time			08/06/2014 10:29:17 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	011	4	2015	H0104 Plan 011 Areas 1 through 6	State of Alabama	2	4540	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	011	5	1	04	01	H0104_011_5	8		1	08/06/2014	2015.01	08/06/2014 10:02:27 AM Central Daylight Time	08/04/2014 03:15:18 PM Central Daylight Time	08/04/2014 03:15:18 PM Central Daylight Time			08/06/2014 10:29:17 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	011	5	2015	H0104 Plan 011 Areas 1 through 6	State of Alabama	2	1260	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	011	6	1	04	01	H0104_011_6	8		1	08/06/2014	2015.01	08/06/2014 10:02:06 AM Central Daylight Time	08/04/2014 03:15:26 PM Central Daylight Time	08/04/2014 03:15:24 PM Central Daylight Time			08/06/2014 10:29:17 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Complete (PPO)	01	04		1			H0104	011	6	2015	H0104 Plan 011 Areas 1 through 6	State of Alabama	2	19497	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0104	801	0	1	04	01	H0104_801_0	2		1	06/24/2014	2015.01	06/24/2014 12:01:00 PM Central Daylight Time	07/02/2014 02:51:06 PM Central Daylight Time				07/03/2014 12:42:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 801 (PPO)	01	04		1			H0104	801	0	2015	State of Alabama		1	100	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H0104	802	0	1	04	01	H0104_802_0	2		1	05/15/2014	2015.01	05/15/2014 01:47:12 PM Central Daylight Time	07/03/2014 12:50:43 PM Central Daylight Time				07/03/2014 12:51:37 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 802 (PPO)	01	04		1			H0104	802	0	2015	State of Alabama		1	100	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H0104	804	0	1	04	01	H0104_804_0	2		1	05/22/2014	2015.01	05/22/2014 12:33:16 PM Central Daylight Time	07/02/2014 02:52:12 PM Central Daylight Time				07/03/2014 12:42:16 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Blue Advantage (PPO)	www.bcbsalmedicare.com	Blue Advantage Employer Group Plan 804 (PPO)	01	04		1			H0104	804	0	2015	State of Alabama		1	100	2			2							www.bcbsalmedicare.com	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	www.bcbsalmedicare.com/sales/plans/blueadvantage/tools.html	(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(888)234-8266		(888)234-8266		(888)873-4707		(888)873-4707		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H0105	001	0	1	20	08	H0105_001_0	1		1	05/20/2014	2015.01	05/20/2014 03:09:01 PM Eastern Daylight Time		05/20/2014 03:00:00 PM Eastern Daylight Time			05/20/2014 03:13:02 PM Eastern Daylight Time	THE METHODIST OAKS	The Methodist Oaks d.b.a. The Oaks PACE	http://www.theoakspace.com	The Methodist Oaks d.b.a. The Oaks PACE (PACE)	08	20		1			H0105	001	0	2015	Rural South Carolina		2		2			2							http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(855)268-5300		(803)268-5300		(855)268-5300		(803)268-5300										(855)268-5300		(803)535-1561		(855)268-5300		(803)268-5300												
H0105	002	0	1	20	08	H0105_002_0	1		1	05/20/2014	2015.01	05/20/2014 03:09:53 PM Eastern Daylight Time		05/20/2014 03:00:00 PM Eastern Daylight Time			05/20/2014 03:13:02 PM Eastern Daylight Time	THE METHODIST OAKS	The Methodist Oaks d.b.a. The Oaks PACE	http://www.theoakspace.com	The Methodist Oaks d.b.a. The Oaks PACE (PACE)	08	20		1			H0105	002	0	2015	Rural South Carolina		2		2			2							http://www.theoakspace.com	www.groveparkpharmacy.com	http://www.theoakspace.com									(855)268-5300		(803)268-5300		(855)268-5300		(803)268-5300										(855)268-5300		(803)535-1561		(855)268-5300		(803)268-5300												
H0107	001	0	1	04	01	H0107_001_0	8		1	07/21/2014	2015.01	07/21/2014 11:01:24 AM Central Daylight Time	08/05/2014 04:04:36 PM Central Daylight Time	08/05/2014 09:09:52 AM Central Daylight Time			08/06/2014 08:12:43 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H0107	001	0	2015	Montana		2	611	2			2								https://myprime.com	https://myprime.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0107	002	0	1	04	01	H0107_002_0	9		1	07/07/2014	2015.01	07/07/2014 10:47:56 AM Central Daylight Time	08/05/2014 04:05:42 PM Central Daylight Time	08/05/2014 09:14:24 AM Central Daylight Time			08/06/2014 08:12:43 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H0107	002	0	2015	Montana		2	152	2			2								https://myprime.com	https://myprime.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0107	801	0	1	04	01	H0107_801_0	4		1	06/02/2014	2015.01	06/02/2014 11:53:44 AM Central Daylight Time	07/22/2014 03:18:34 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.hcsc.com	Blue Cross Medicare Advantage Employer Ideal (PPO)	01	04		1			H0107	801	0	2015	Montana		1	100	2			2								https://myprime.com	https://myprime.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H0107	802	0	1	04	01	H0107_802_0	4		1	06/02/2014	2015.01	06/02/2014 11:55:00 AM Central Daylight Time	07/22/2014 03:20:24 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of Montana	www.hcsc.com	Blue Cross Medicare Advantage Employer Expanded (PPO)	01	04		1			H0107	802	0	2015	Montana		1	100	2			2								https://myprime.com	https://myprime.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H0108	004	0	1	01	01	H0108_004_0	3		1	08/02/2014	2015.02	08/02/2014 11:04:15 AM Eastern Daylight Time	08/04/2014 08:52:56 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-004 (HMO)	01	01		1			H0108	004	0	2015	Fresno, Kings and Madera counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	005	0	1	01	01	H0108_005_0	3		1	08/01/2014	2015.02	08/01/2014 08:04:53 PM Eastern Daylight Time	08/04/2014 08:53:42 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-005 (HMO)	01	01		1			H0108	005	0	2015	Riverside and San Bernardino counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	006	0	1	01	01	H0108_006_0	3		1	08/02/2014	2015.02	08/02/2014 11:04:39 AM Eastern Daylight Time	08/04/2014 08:51:44 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-006 (HMO)	01	01		1			H0108	006	0	2015	Riverside and San Bernardino counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	008	0	1	01	01	H0108_008_0	5		1	08/01/2014	2015.02	08/01/2014 08:11:50 PM Eastern Daylight Time	08/04/2014 08:56:16 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-008 (HMO)	01	01		1			H0108	008	0	2015	San Diego County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	009	0	1	01	01	H0108_009_0	3		1	08/01/2014	2015.02	08/01/2014 08:15:05 PM Eastern Daylight Time	08/04/2014 08:55:16 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-009 (HMO)	01	01		1			H0108	009	0	2015	San Diego County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	010	0	1	01	01	H0108_010_0	3		1	08/01/2014	2015.02	08/01/2014 08:18:41 PM Eastern Daylight Time	08/04/2014 08:57:12 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-010 (HMO)	01	01		1			H0108	010	0	2015	Fresno, Kings and Madera counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	011	0	1	01	01	H0108_011_0	3		1	08/02/2014	2015.02	08/02/2014 11:10:55 AM Eastern Daylight Time	08/04/2014 09:02:12 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-011 (HMO)	01	01		1			H0108	011	0	2015	Los Angeles and Orange counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	021	0	1	01	01	H0108_021_0	3		1	08/01/2014	2015.02	08/01/2014 09:26:31 PM Eastern Daylight Time	08/04/2014 09:18:00 AM Eastern Daylight Time	08/04/2014 05:04:05 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-021 (HMO)	01	01		1			H0108	021	0	2015	San Joaquin County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	022	0	1	01	01	H0108_022_0	3		1	08/01/2014	2015.02	08/01/2014 09:30:28 PM Eastern Daylight Time	08/04/2014 09:05:34 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-022 (HMO)	01	01		1			H0108	022	0	2015	San Joaquin County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	023	0	1	01	01	H0108_023_0	3		1	08/01/2014	2015.02	08/01/2014 09:33:46 PM Eastern Daylight Time	08/04/2014 09:19:26 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-023 (HMO)	01	01		1			H0108	023	0	2015	Contra Costa County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	024	0	1	01	01	H0108_024_0	3		1	08/01/2014	2015.02	08/01/2014 09:37:12 PM Eastern Daylight Time	08/04/2014 09:23:13 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-024 (HMO)	01	01		1			H0108	024	0	2015	Contra Costa County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	025	0	1	01	01	H0108_025_0	3		1	08/01/2014	2015.02	08/01/2014 09:40:48 PM Eastern Daylight Time	08/04/2014 09:20:18 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-025 (HMO)	01	01		1			H0108	025	0	2015	Alameda County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	026	0	1	01	01	H0108_026_0	3		1	08/01/2014	2015.02	08/01/2014 09:44:11 PM Eastern Daylight Time	08/04/2014 09:24:21 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-026 (HMO)	01	01		1			H0108	026	0	2015	Alameda County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	027	0	1	01	01	H0108_027_0	3		1	08/01/2014	2015.02	08/01/2014 09:48:07 PM Eastern Daylight Time	08/04/2014 09:04:38 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-027 (HMO)	01	01		1			H0108	027	0	2015	San Francisco County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	028	0	1	01	01	H0108_028_0	3		1	08/01/2014	2015.02	08/01/2014 09:51:28 PM Eastern Daylight Time	08/04/2014 09:03:48 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-028 (HMO)	01	01		1			H0108	028	0	2015	San Francisco County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	029	0	1	01	01	H0108_029_0	2		1	07/10/2014	2015.02	07/10/2014 01:02:22 PM Eastern Daylight Time	07/11/2014 04:32:56 PM Eastern Daylight Time				07/14/2014 01:31:16 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-029 (HMO)	01	01		1			H0108	029	0	2015	San Diego County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H0108	034	0	1	01	01	H0108_034_0	3		1	08/01/2014	2015.02	08/01/2014 09:55:05 PM Eastern Daylight Time	08/04/2014 09:27:55 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-034 (HMO)	01	01		1			H0108	034	0	2015	Santa Clara County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	035	0	1	01	01	H0108_035_0	3		1	08/01/2014	2015.02	08/01/2014 09:58:57 PM Eastern Daylight Time	08/04/2014 09:30:38 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-035 (HMO)	01	01		1			H0108	035	0	2015	Stanislaus County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	037	0	1	01	01	H0108_037_0	3		1	08/01/2014	2015.02	08/01/2014 10:03:17 PM Eastern Daylight Time	08/04/2014 09:26:53 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-037 (HMO)	01	01		1			H0108	037	0	2015	Santa Clara County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	038	0	1	01	01	H0108_038_0	3		1	08/01/2014	2015.02	08/01/2014 08:35:43 PM Eastern Daylight Time	08/04/2014 09:26:01 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-038 (HMO)	01	01		1			H0108	038	0	2015	Santa Barbara and Ventura counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	039	0	1	01	01	H0108_039_0	3		1	08/01/2014	2015.02	08/01/2014 10:06:29 PM Eastern Daylight Time	08/04/2014 09:29:49 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-039 (HMO)	01	01		1			H0108	039	0	2015	Stanislaus County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	041	0	1	01	01	H0108_041_0	4		1	08/01/2014	2015.02	08/01/2014 10:09:57 PM Eastern Daylight Time	08/04/2014 09:31:40 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-041 (HMO)	01	01		1			H0108	041	0	2015	Select Counties in California		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	045	0	1	01	01	H0108_045_0	3		1	07/10/2014	2015.02	07/10/2014 12:24:56 PM Eastern Daylight Time	08/04/2014 09:28:59 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-045 (HMO)	01	01		1			H0108	045	0	2015	Santa Cruz County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	046	0	1	01	01	H0108_046_0	3		1	08/01/2014	2015.02	08/01/2014 08:40:31 PM Eastern Daylight Time	08/04/2014 09:25:09 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-046 (HMO)	01	01		1			H0108	046	0	2015	Tulare County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	047	0	1	01	01	H0108_047_0	3		1	08/01/2014	2015.02	08/01/2014 08:45:11 PM Eastern Daylight Time	08/04/2014 09:36:44 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-047 (HMO)	01	01		1			H0108	047	0	2015	Los Angeles and Orange counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	048	0	1	01	01	H0108_048_0	3	2	1	08/01/2014	2015.02	08/01/2014 08:59:33 PM Eastern Daylight Time	08/04/2014 09:59:06 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H0108-048 (HMO SNP)	01	01		1			H0108	048	0	2015	Select Counties in California		2		2			1	3		1	3		2	www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	050	0	1	01	01	H0108_050_0	3		1	07/10/2014	2015.02	07/10/2014 01:08:47 PM Eastern Daylight Time	08/04/2014 09:57:59 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:49:30 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-050 (HMO)	01	01		1			H0108	050	0	2015	Select Counties in California		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	054	0	1	01	01	H0108_054_0	3		1	08/01/2014	2015.02	08/01/2014 10:13:20 PM Eastern Daylight Time	08/04/2014 09:51:39 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-054 (HMO)	01	01		1			H0108	054	0	2015	Placer County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	055	0	1	01	01	H0108_055_0	3		1	08/01/2014	2015.02	08/01/2014 10:16:31 PM Eastern Daylight Time	08/04/2014 09:53:31 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-055 (HMO)	01	01		1			H0108	055	0	2015	Placer County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	056	0	1	01	01	H0108_056_0	3		1	08/01/2014	2015.02	08/01/2014 10:19:42 PM Eastern Daylight Time	08/04/2014 09:49:05 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-056 (HMO)	01	01		1			H0108	056	0	2015	Sacramento County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	057	0	1	01	01	H0108_057_0	3		1	08/01/2014	2015.02	08/01/2014 10:22:49 PM Eastern Daylight Time	08/04/2014 09:55:45 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-057 (HMO)	01	01		1			H0108	057	0	2015	Sacramento County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	058	0	1	01	01	H0108_058_0	3		1	08/01/2014	2015.02	08/01/2014 10:26:12 PM Eastern Daylight Time	08/04/2014 09:46:40 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-058 (HMO)	01	01		1			H0108	058	0	2015	Yolo County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	059	0	1	01	01	H0108_059_0	3		1	08/01/2014	2015.02	08/01/2014 10:29:19 PM Eastern Daylight Time	08/04/2014 09:56:56 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/05/2014 05:25:32 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Gold Plus H0108-059 (HMO)	01	01		1			H0108	059	0	2015	Yolo County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0108	801	0	1	01	01	H0108_801_0	5		1	05/23/2014	2015.02	05/23/2014 02:24:22 PM Eastern Daylight Time	07/14/2014 10:45:59 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H0108	801	0	2015	Select Counties in California		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0108	802	0	1	01	01	H0108_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:25:03 PM Eastern Daylight Time	07/14/2014 10:48:06 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Humana Health Plan of California, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H0108	802	0	2015	Select counties in California		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0112	001	0	1	20	08	H0112_001_0	1		1	05/30/2014	2015.01	05/30/2014 10:51:00 AM Eastern Daylight Time		05/29/2014 11:46:52 AM Eastern Daylight Time			05/30/2014 10:53:31 AM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	001	0	2015	Palm Beach County (partial)		2		2			2								N/A	MorseLife.org									(855)572-7223		(561)687-5745		(855)572-7223		(561)687-5745										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771												
H0112	002	0	1	20	08	H0112_002_0	1		1	05/30/2014	2015.01	05/30/2014 10:51:31 AM Eastern Daylight Time		05/29/2014 11:54:07 AM Eastern Daylight Time			05/30/2014 10:53:31 AM Eastern Daylight Time	MORSE LIFE HOME CARE, INC.	Palm Beach PACE	MorseLife.org	Palm Beach PACE (PACE)	08	20		1			H0112	002	0	2015	Palm Beach County (partial)		2		2			2								N/A	MorseLife.org									(855)572-7223		(561)687-5745		(855)572-7223		(561)687-5745										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771												
H0137	001	0	1	48	05	H0137_001_0	4		1	07/01/2014	2015.01	07/01/2014 10:10:01 AM Eastern Daylight Time					07/01/2014 10:12:52 AM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthonecare.org	Commonwealth Care Alliance (Medicare-Medicaid Plan)	05	48		1			H0137	001	0	2015	ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF, WOR.		2	14027	2			2							www.commonwealthcare.org	www.commonwealthonecare.org/pharmacy-program/formulary	www.commonwealthonecare.org/pharmacy-program/overview	(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0141	004	1	1	01	01	H0141_004_1	8		1	07/10/2014	2015.01	07/10/2014 02:11:56 PM Eastern Daylight Time	08/06/2014 10:54:42 AM Eastern Daylight Time	08/05/2014 02:27:24 PM Eastern Daylight Time			08/06/2014 05:51:28 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLarenAdvantage	www.mclarenadvantage.org	McLaren Advantage Diamond (HMO)	01	01		1			H0141	004	1	2015	35 Counties in Michigan	Counties: BA, CB, CN, EM, GE, IN, IB, LP, MB, OK	2	75	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		2					2					2
H0141	004	2	1	01	01	H0141_004_2	9		1	07/10/2014	2015.01	07/10/2014 02:13:12 PM Eastern Daylight Time	08/06/2014 10:59:04 AM Eastern Daylight Time	08/05/2014 02:27:00 PM Eastern Daylight Time			08/06/2014 05:51:28 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLarenAdvantage	www.mclarenadvantage.org	McLaren Advantage Diamond (HMO)	01	01		1			H0141	004	2	2015	35 Counties in Michigan	Counties EXCEPT: BA,CB,CN,EM,GE,IN,IB,LP,MB,OK	2	1	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		2					2					2
H0141	005	1	1	01	01	H0141_005_1	9		1	07/10/2014	2015.01	07/10/2014 02:16:25 PM Eastern Daylight Time	08/06/2014 10:52:28 AM Eastern Daylight Time	08/05/2014 02:26:38 PM Eastern Daylight Time			08/06/2014 05:51:28 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLarenAdvantage	www.mclarenadvantage.org	McLaren Advantage Sapphire (HMO)	01	01		1			H0141	005	1	2015	35 Counties in Michigan	Counties: BA, CB, CN, EM, GE, IN, IB, LP, MB, OK	2	675	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		2					2					2
H0141	005	3	1	01	01	H0141_005_3	9		1	07/10/2014	2015.01	07/10/2014 02:17:18 PM Eastern Daylight Time	08/06/2014 10:48:18 AM Eastern Daylight Time	08/05/2014 02:26:20 PM Eastern Daylight Time			08/06/2014 05:51:28 PM Eastern Daylight Time	MCLAREN HEALTH PLAN, INC.	McLarenAdvantage	www.mclarenadvantage.org	McLaren Advantage Sapphire (HMO)	01	01		1			H0141	005	3	2015	35 Counties in Michigan	Counties EXCEPT: BA,CB,CN,EM,GE,IN,IB,LP,MB,OK	2	1	2			2							www.mclarenadvantage.org	www.mclarenadvantage.org	www.mclarenadvantage.org	(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(888)327-0671		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		(800)356-3232		2					2					2
H0147	001	0	1	48	05	H0147_001_0	4		1	07/24/2014	2015.01	07/24/2014 01:27:29 PM Eastern Daylight Time					08/04/2014 10:14:07 AM Eastern Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	HealthKeepers (Medicare-Medicaid Plan)	05	48		1			H0147	001	0	2015	HealthKeepers Medicare-Medicaid Plan		2	500	2			2								www.anthem.com	www.anthem.com	(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)817-5787		(855)558-1434		(855)558-1434		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H0148	001	0	1	48	05	H0148_001_0	2		1	07/03/2014	2015.01	07/03/2014 03:48:06 PM Pacific Daylight Time					07/03/2014 03:55:12 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1st.com/ca/	Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	001	0	2015	Care1st Health Plan San Diego County		2	7500	2			2							www.care1st.com/ca/	www.care1st.com/ca/	www.care1st.com/ca/	(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0148	002	0	1	48	05	H0148_002_0	3		1	07/03/2014	2015.01	07/03/2014 04:00:38 PM Pacific Daylight Time					07/03/2014 04:06:59 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1st.com/ca/	Care1st Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H0148	002	0	2015	Care1st Health Plan Los Angeles County		2	16000	2			2							www.care1st.com/ca/	www.care1st.com/ca/	www.care1st.com/ca/	(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(855)905-3825		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0150	007	0	1	01	01	H0150_007_0	4	2	1	07/16/2014	2015.02	07/16/2014 02:32:52 PM Central Daylight Time	05/26/2014 10:45:57 AM Central Daylight Time	07/31/2014 03:45:16 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H0150	007	0	2015	Alabama		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0150	012	0	1	01	01	H0150_012_0	2		1	07/16/2014	2015.02	07/16/2014 02:33:05 PM Central Daylight Time	05/26/2014 10:46:21 AM Central Daylight Time				07/17/2014 09:49:34 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H0150	012	0	2015	Alabama		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2
H0150	024	1	1	01	01	H0150_024_1	4		1	07/16/2014	2015.02	07/16/2014 02:33:22 PM Central Daylight Time	08/04/2014 01:23:46 PM Central Daylight Time	07/31/2014 03:45:27 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0150	024	1	2015	Alabama	Alabama Preferred	2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0150	024	2	1	01	01	H0150_024_2	4		1	07/16/2014	2015.02	07/16/2014 02:33:34 PM Central Daylight Time	08/04/2014 01:24:44 PM Central Daylight Time	07/31/2014 03:45:37 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0150	024	2	2015	Alabama	Alabama Preferred Select Counties	2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0150	804	0	1	01	01	H0150_804_0	2		1	06/09/2014	2015.02	06/09/2014 11:31:12 AM Central Daylight Time	06/04/2014 04:17:23 PM Central Daylight Time				06/09/2014 03:57:47 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0150	804	0	2015	Alabama		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H0150	808	0	1	02	01	H0150_808_0	1		1	05/14/2014	2015.02	05/14/2014 10:21:28 AM Central Daylight Time	05/26/2014 10:48:56 AM Central Daylight Time				05/29/2014 07:03:05 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H0150	808	0	2015	Alabama		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H0150	809	0	1	01	01	H0150_809_0	1		1	05/14/2014	2015.02	05/14/2014 10:22:12 AM Central Daylight Time	05/26/2014 10:49:21 AM Central Daylight Time				05/29/2014 07:03:05 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H0150	809	0	2015	Alabama		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H0150	810	0	1	01	01	H0150_810_0	1		1	05/14/2014	2015.02	05/14/2014 10:22:29 AM Central Daylight Time	05/26/2014 10:49:46 AM Central Daylight Time				05/29/2014 07:03:05 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0150	810	0	2015	Alabama		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H0150	811	0	1	02	01	H0150_811_0	1		1	05/14/2014	2015.02	05/14/2014 10:22:37 AM Central Daylight Time	05/26/2014 10:50:09 AM Central Daylight Time				05/29/2014 07:03:05 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H0150	811	0	2015	Alabama		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H0150	812	0	1	02	01	H0150_812_0	1		1	05/14/2014	2015.02	05/14/2014 10:22:45 AM Central Daylight Time	05/26/2014 10:50:31 AM Central Daylight Time				05/29/2014 07:03:05 PM Central Daylight Time	HEALTHSPRING OF ALABAMA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H0150	812	0	2015	Alabama		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H0151	001	0	1	01	01	H0151_001_0	2		1	05/30/2014	2015.02	05/30/2014 04:16:19 PM Central Daylight Time	08/04/2014 02:37:08 PM Central Daylight Time	07/31/2014 03:18:24 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0151	001	0	2015	Select counties in Alabama		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0151	015	0	1	01	01	H0151_015_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:00:43 AM Central Daylight Time	08/04/2014 03:59:52 PM Central Daylight Time	07/31/2014 03:18:34 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0151	015	0	2015	Select counties in Alabama		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0151	025	0	1	01	01	H0151_025_0	2		1	05/30/2014	2015.02	05/30/2014 04:16:38 PM Central Daylight Time	08/04/2014 02:50:37 PM Central Daylight Time	07/31/2014 03:18:42 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H0151	025	0	2015	Select counties in Alabama		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0151	801	0	1	01	01	H0151_801_0	3		1	05/27/2014	2015.01	05/27/2014 08:29:38 AM Central Daylight Time	06/05/2014 01:59:51 PM Central Daylight Time				06/09/2014 02:31:29 PM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0151	801	0	2015	Select Counties in Alabama		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H0151	804	0	1	01	01	H0151_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:01:51 AM Central Daylight Time	05/30/2014 04:49:32 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0151	804	0	2015	Select Counties in Alabama		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H0151	805	0	1	01	01	H0151_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:02:02 AM Central Daylight Time	05/30/2014 04:50:07 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UNITEDHEALTHCARE OF ALABAMA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0151	805	0	2015	Select Counties in Alabama		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H0154	001	0	1	01	01	H0154_001_0	5		1	08/01/2014	2015.01	08/01/2014 11:00:53 AM Central Daylight Time	08/01/2014 05:35:18 PM Central Daylight Time	08/01/2014 05:35:18 PM Central Daylight Time			08/01/2014 06:20:45 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Plus (HMO)	01	01		1			H0154	001	0	2015	Central Alabama and Mobile Area		2	21279	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0154	008	0	1	01	01	H0154_008_0	4		1	07/21/2014	2015.01	07/21/2014 09:04:56 AM Central Daylight Time	05/29/2014 04:42:12 PM Central Daylight Time				07/21/2014 11:45:47 AM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Select (HMO)	01	01		1			H0154	008	0	2015	Central Alabama and Mobile Area		2	767	2			2							www.vivaprovider.com	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										2					2					2
H0154	011	0	1	01	01	H0154_011_0	5		1	08/01/2014	2015.01	08/01/2014 12:21:19 PM Central Daylight Time	08/01/2014 05:35:19 PM Central Daylight Time	08/01/2014 05:35:16 PM Central Daylight Time			08/01/2014 06:20:45 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Premier (HMO)	01	01		1			H0154	011	0	2015	Central Alabama and Mobile Area		2	3833	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0154	012	0	1	01	01	H0154_012_0	4	2	1	08/01/2014	2015.01	08/01/2014 05:25:07 PM Central Daylight Time	08/01/2014 05:35:17 PM Central Daylight Time	08/01/2014 05:35:17 PM Central Daylight Time			08/01/2014 06:20:45 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Extra Value (HMO SNP)	01	01		1			H0154	012	0	2015	Central Alabama and Mobile Area		2	17690	2			1	3		1	4			www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0154	014	0	1	01	01	H0154_014_0	6		1	08/01/2014	2015.01	08/01/2014 11:34:58 AM Central Daylight Time	08/01/2014 05:35:17 PM Central Daylight Time	08/01/2014 05:35:18 PM Central Daylight Time			08/01/2014 06:20:45 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Me (HMO)	01	01		1			H0154	014	0	2015	Central Alabama		2	1504	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0154	801	0	1	01	01	H0154_801_0	3		1	05/28/2014	2015.01	05/28/2014 04:53:12 PM Central Daylight Time	07/01/2014 12:03:11 PM Central Daylight Time				07/14/2014 04:56:12 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Group Plan with Rx (CY) (HMO)	01	01		1			H0154	801	0	2015	State of Alabama		1	50	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111110111011111000100	2		1					2
H0154	802	0	1	01	01	H0154_802_0	3		1	05/28/2014	2015.01	05/28/2014 10:33:34 AM Central Daylight Time	07/01/2014 12:04:04 PM Central Daylight Time				07/14/2014 04:56:12 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Group Plan (no Rx) (HMO)	01	01		1			H0154	802	0	2015	State of Alabama		1	50	2			2							www.vivaprovider.com	http://www.vivamedicaremember.com/Download.aspx?ID=1326&Type=doc	http://www.vivamedicaremember.com/Download.aspx?ID=992&Type=doc	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111110111011111000100	2		1					1
H0154	803	0	1	01	01	H0154_803_0	3		1	05/28/2014	2015.01	05/28/2014 11:26:01 AM Central Daylight Time	07/01/2014 12:04:45 PM Central Daylight Time				07/14/2014 04:56:12 PM Central Daylight Time	VIVA HEALTH, INC.	VIVA Medicare	www.vivamedicaremember.com/	VIVA Medicare Plus Group Plan with Rx (not CY) (HMO)	01	01		1			H0154	803	0	2015	State of Alabama		1	50	2			2							www.vivaprovider.com	www.vivamedicaremember.com/Resource/Current/Formulary.aspx	www.vivamedicaremember.com/Resource/Current/Pharmacy.aspx	(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(800)633-1542		(205)918-2067		(888)830-8482		(205)933-8482		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111110111011111000100	2		1					2
H0192	001	0	1	48	05	H0192_001_0	7		1	10/16/2014	2015.02	10/16/2014 08:10:10 AM Central Daylight Time					10/16/2014 10:03:33 AM Central Daylight Time	AMERIHEALTH MICHIGAN, INC.	Amerihealth VIP Care Plus	www.amerihealthvipcareplus.com	AmeriHealth VIP Care PLUS (Medicare-Medicaid Plan)	05	48		1			H0192	001	0	2015	Wayne and Macomb Counties		2		2			2							www.amerihealthvipcareplus.com	www.amerihealthvipcareplus.com	www.amerihealthvipcareplus.com	(888)667-0318		(888)667-0318		(877)694-2316		(877)694-2316		(855)328-0011		(855)328-0011		(877)694-2316		(877)694-2316		(866)428-7583		(866)428-7583		(855)241-3649		(855)241-3649		(711)-		(711)-		(855)241-3649		(855)241-3649		2					2					2
H0216	001	0	1	20	08	H0216_001_0	1		1	05/20/2014	2015.01	05/20/2014 12:28:16 PM Central Daylight Time		05/19/2014 10:00:16 AM Central Daylight Time			05/20/2014 12:30:50 PM Central Daylight Time	PACE IOWA	Immanuel Pathways	immanuelpathways.org	PACE Iowa (PACE)	08	20		1			H0216	001	0	2015	PACE Iowa		2		2			2								www.immanuelcommunities.com	www.immanuelcommunities.com									(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284										(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284												
H0216	002	0	1	20	08	H0216_002_0	1		1	05/20/2014	2015.01	05/20/2014 12:28:28 PM Central Daylight Time		05/19/2014 10:09:46 AM Central Daylight Time			05/20/2014 12:30:50 PM Central Daylight Time	PACE IOWA	Immanuel Pathways	www.immanuelcommunities.com/pathways	PACE Iowa (PACE)	08	20		1			H0216	002	0	2015	PACE Iowa		2		2			2								www.immanuelcommunities.com	www.immanuelcommunities.com									(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284										(800)000-0000		(712)256-7284		(800)000-0000		(712)256-7284												
H0251	002	0	1	01	01	H0251_002_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:00:51 AM Central Daylight Time	08/04/2014 04:06:01 PM Central Daylight Time	07/31/2014 03:18:51 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0251	002	0	2015	Select counties in Tennessee		2		2			1	3		1	5			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(800)690-1606		(800)690-1606		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0281	001	0	1	48	05	H0281_001_0	3		1	06/23/2014	2015.01	06/23/2014 12:25:24 PM Central Daylight Time					06/23/2014 12:36:57 PM Central Daylight Time	ILLINICARE HEALTH PLAN	IlliniCare Health	http://www.illinicare.com/	IlliniCare Health - MMAI (Medicare-Medicaid Plan)	05	48		1			H0281	001	0	2015	Cook, DuPage, Kane, Kankakee, Lake, Will Counties		2	500	2			2							http://www.illinicare.com/	http://www.illinicare.com/	http://www.illinicare.com/	(866)329-4701		(866)329-4701		(866)329-4701		(866)329-4701		(866)329-4701		(866)329-4701		(866)329-4701		(866)329-4701		(866)811-2452		(866)811-2452		(866)811-2452		(866)811-2452		(866)811-2452		(866)811-2452		(866)811-2452		(866)811-2452		2					2					2
H0294	002	0	1	04	01	H0294_002_0	4		1	07/16/2014	2015.02	07/16/2014 03:26:12 PM Central Daylight Time	08/04/2014 04:06:38 PM Central Daylight Time	07/31/2014 03:18:59 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H0294	002	0	2015	Various Counties in Wisconsin		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0294	004	0	1	04	01	H0294_004_0	3		1	07/16/2014	2015.02	07/16/2014 03:29:56 PM Central Daylight Time	08/04/2014 02:37:49 PM Central Daylight Time	07/31/2014 03:19:07 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H0294	004	0	2015	Various Counties in Wisconsin		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0294	006	0	1	04	01	H0294_006_0	3	2	1	07/16/2014	2015.02	07/16/2014 02:14:09 PM Central Daylight Time	08/04/2014 04:06:54 PM Central Daylight Time	07/31/2014 03:19:16 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (PPO SNP)	01	04		1			H0294	006	0	2015	Various Counties in Wisconsin		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0302	001	0	1	01	01	H0302_001_0	15		1	09/11/2014	2015.01	09/11/2014 02:01:21 PM US Mountain Standard Time	08/06/2014 12:46:40 PM US Mountain Standard Time	08/06/2014 01:56:09 PM US Mountain Standard Time			09/11/2014 02:03:07 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	http://www.azbluemedicare.com/	Blue Medicare Advantage Plus (HMO)	01	01		1			H0302	001	0	2015	Maricopa County and part of Pinal County		2	12406	2			2							http://www.azbluemedicare.com/	https://www.azbluemedicare.com/home/search-drug-list	https://www.azbluemedicare.com/home/search-drug-list	(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0302	006	0	1	01	01	H0302_006_0	12		1	09/11/2014	2015.01	09/11/2014 02:00:51 PM US Mountain Standard Time	08/06/2014 01:55:32 PM US Mountain Standard Time	08/06/2014 01:56:18 PM US Mountain Standard Time			09/11/2014 02:08:31 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	http://www.azbluemedicare.com/	Blue Medicare Advantage Classic (HMO)	01	01		1			H0302	006	0	2015	Maricopa County and part of Pinal County		2	8288	2			2							http://www.azbluemedicare.com/	https://www.azbluemedicare.com/home/search-drug-list	https://www.azbluemedicare.com/home/search-drug-list	(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0302	007	0	1	01	01	H0302_007_0	10		1	07/24/2014	2015.01	07/24/2014 08:22:48 AM US Mountain Standard Time	08/06/2014 01:54:05 PM US Mountain Standard Time	08/06/2014 01:56:26 PM US Mountain Standard Time			08/06/2014 02:00:34 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	http://www.azbluemedicare.com/	Blue Medicare Advantage Premier (HMO)	01	01		1			H0302	007	0	2015	Maricopa County and part of Pinal County		2	5234	2			2							http://www.azbluemedicare.com/	https://www.azbluemedicare.com/home/search-drug-list	https://www.azbluemedicare.com/home/search-drug-list	(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0302	008	0	1	01	01	H0302_008_0	9		1	09/11/2014	2015.01	09/11/2014 02:00:13 PM US Mountain Standard Time	08/06/2014 01:55:43 PM US Mountain Standard Time	08/06/2014 01:56:34 PM US Mountain Standard Time			09/11/2014 02:12:18 PM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	www.azbluemedicare.com/	Blue Medicare Advantage Classic Pima (HMO)	01	01		1			H0302	008	0	2015	Pima County		2	800	2			2							http://www.azbluemedicare.com/	https://www.azbluemedicare.com/home/search-drug-list	https://www.azbluemedicare.com/home/search-drug-list	(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0302	801	0	1	01	01	H0302_801_0	3		1	07/14/2014	2015.01	07/14/2014 02:09:31 PM US Mountain Standard Time	07/23/2014 10:50:04 AM US Mountain Standard Time				07/23/2014 11:06:21 AM US Mountain Standard Time	MEDISUN, INC.	Blue Cross Blue Shield of Arizona Advantage	www.azbluemedicare.com	Blue Medicare Advantage Employer Plan (HMO)	01	01		1			H0302	801	0	2015	Arizona		1	8544	2			2							http://www.azbluemedicare.com/	https://www.azbluemedicare.com/home/search-drug-list	https://www.azbluemedicare.com/home/search-drug-list	(800)446-8331		(623)974-7430		(800)422-0761		(800)422-0761										(711)-		(711)-		(711)-		(711)-										1	1	000110000010001000111110011100000000	1	010010111011011111110000000	1					1
H0303	013	0	1	01	01	H0303_013_0	3		1	05/30/2014	2015.02	05/30/2014 04:26:53 PM Central Daylight Time	08/04/2014 02:38:24 PM Central Daylight Time	07/31/2014 03:19:24 PM Central Daylight Time			08/06/2014 09:44:23 AM Central Daylight Time	PACIFICARE OF ARIZONA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H0303	013	0	2015	Pima County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0303	015	0	1	01	01	H0303_015_0	4		1	05/30/2014	2015.02	05/30/2014 04:27:02 PM Central Daylight Time	08/04/2014 02:38:40 PM Central Daylight Time	07/31/2014 03:19:33 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	PACIFICARE OF ARIZONA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H0303	015	0	2015	Maricopa and Pinal counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)370-2843		(877)370-2843		(800)547-5514		(800)547-5514		(877)370-2843		(877)370-2843		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0303	801	0	1	01	01	H0303_801_0	1		1	05/23/2014	2015.01	05/23/2014 01:58:25 PM Central Daylight Time	05/30/2014 05:03:06 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF ARIZONA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0303	801	0	2015	AZ Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H0303	804	0	1	01	01	H0303_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:01:26 AM Central Daylight Time	05/30/2014 05:03:36 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF ARIZONA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0303	804	0	2015	AZ Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0303	805	0	1	01	01	H0303_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:01:18 AM Central Daylight Time	05/30/2014 05:04:06 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF ARIZONA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0303	805	0	2015	AZ Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0316	002	0	1	02	01	H0316_002_0	5		1	05/30/2014	2015.02	05/30/2014 04:27:14 PM Central Daylight Time	08/04/2014 05:38:41 PM Central Daylight Time	07/31/2014 03:19:41 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF ARIZONA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus (HMO-POS)	01	02		1			H0316	002	0	2015	Southern Arizona Area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0316	014	0	1	01	01	H0316_014_0	4		1	05/30/2014	2015.02	05/30/2014 04:27:22 PM Central Daylight Time	08/04/2014 02:39:30 PM Central Daylight Time	07/31/2014 03:19:50 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF ARIZONA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H0316	014	0	2015	Yavapai County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0316	801	0	1	01	01	H0316_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:02:11 AM Central Daylight Time	05/30/2014 04:38:04 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UNITEDHEALTHCARE OF ARIZONA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0316	801	0	2015	AZ Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H0316	804	0	1	01	01	H0316_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:02:20 AM Central Daylight Time	05/30/2014 04:38:37 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UNITEDHEALTHCARE OF ARIZONA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0316	804	0	2015	AZ Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H0316	806	0	1	01	01	H0316_806_0	1		1	05/22/2014	2015.01	05/22/2014 09:02:49 AM Central Daylight Time	05/30/2014 04:39:09 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UNITEDHEALTHCARE OF ARIZONA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0316	806	0	2015	AZ Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H0318	007	0	1	01	01	H0318_007_0	7		1	08/03/2014	2015.01	08/03/2014 03:16:41 PM Eastern Daylight Time	08/05/2014 12:49:43 PM Eastern Daylight Time	07/31/2014 05:19:31 PM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H0318	007	0	2015	Maricopa county		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0318	801	0	1	01	01	H0318_801_0	2		1	05/29/2014	2015.01	05/29/2014 09:37:08 AM Eastern Daylight Time	06/01/2014 01:42:08 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0318	801	0	2015	Arizona		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H0318	802	0	1	01	01	H0318_802_0	2		1	05/19/2014	2015.01	05/19/2014 12:54:55 PM Eastern Daylight Time	06/01/2014 01:40:16 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H0318	802	0	2015	Arizona		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H0319	001	0	1	04	01	H0319_001_0	4		1	05/30/2014	2015.02	05/30/2014 11:11:47 AM Central Daylight Time	08/04/2014 05:41:37 PM Central Daylight Time	07/31/2014 03:20:00 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0319	001	0	2015	Maricopa, Pima and Pinal counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0321	002	0	1	01	01	H0321_002_0	3	2	1	07/18/2014	2015.02	07/18/2014 08:58:29 AM Central Daylight Time	08/04/2014 04:08:02 PM Central Daylight Time	07/31/2014 03:20:09 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0321	002	0	2015	Select counties in Arizona		2		2			1	3		1	4			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0321	004	0	1	01	01	H0321_004_0	5	2	1	07/18/2014	2015.02	07/18/2014 08:58:41 AM Central Daylight Time	08/04/2014 04:08:18 PM Central Daylight Time	07/31/2014 03:20:19 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	ARIZONA PHYSICIANS IPA, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H0321	004	0	2015	Select counties in Arizona		2		2			1	3		1	4			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(877)614-0623		(877)614-0623		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0332	001	0	1	01	01	H0332_001_0	4		1	07/17/2014	2015.01	07/17/2014 06:09:07 PM Central Daylight Time	05/31/2014 08:29:50 AM Central Daylight Time				07/17/2014 06:36:04 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential (HMO)	01	01		1			H0332	001	0	2015	Harris, Ft Bend, Galveston and Montgomery counties		2	3670	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2
H0332	002	0	1	01	01	H0332_002_0	5		1	08/12/2014	2015.01	08/12/2014 04:37:57 PM Central Daylight Time	08/14/2014 10:33:05 AM Central Daylight Time	08/05/2014 05:38:19 PM Central Daylight Time			08/14/2014 10:55:27 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx (HMO)	01	01		1			H0332	002	0	2015	Harris, Ft Bend, Galveston and Montgomery counties		2	17070	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	003	0	1	02	01	H0332_003_0	4		1	07/17/2014	2015.01	07/17/2014 03:50:37 PM Central Daylight Time	05/31/2014 08:32:18 AM Central Daylight Time				07/17/2014 06:36:04 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice (HMO-POS)	01	02		1			H0332	003	0	2015	Harris, Ft Bend, Galveston and Montgomery counties		2	1363	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2
H0332	004	0	1	02	01	H0332_004_0	7		1	08/12/2014	2015.01	08/12/2014 04:48:23 PM Central Daylight Time	08/14/2014 10:37:28 AM Central Daylight Time	08/05/2014 05:39:21 PM Central Daylight Time			08/14/2014 10:55:27 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice (HMO-POS)	01	02		1			H0332	004	0	2015	Harris, Ft Bend, Galveston and Montgomery counties		2	1182	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	006	0	1	01	01	H0332_006_0	7		1	08/08/2014	2015.01	08/08/2014 10:54:01 AM Central Daylight Time	08/14/2014 10:38:29 AM Central Daylight Time	08/05/2014 05:40:23 PM Central Daylight Time			08/14/2014 10:55:27 AM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Premier (HMO)	01	01		1			H0332	006	0	2015	Harris, Ft Bend, Galveston and Montgomery counties		2	227	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	801	0	1	01	01	H0332_801_0	4		1	06/02/2014	2015.01	06/02/2014 02:21:09 PM Central Daylight Time	05/31/2014 08:36:40 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	801	0	2015	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2
H0332	803	0	1	01	01	H0332_803_0	4		1	06/02/2014	2015.01	06/02/2014 02:33:54 PM Central Daylight Time	05/31/2014 08:37:51 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	803	0	2015	Texas		1	62	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	804	0	1	01	01	H0332_804_0	4		1	06/02/2014	2015.01	06/02/2014 02:34:27 PM Central Daylight Time	05/31/2014 08:39:06 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	804	0	2015	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2
H0332	805	0	1	01	01	H0332_805_0	4		1	06/02/2014	2015.01	06/02/2014 02:34:53 PM Central Daylight Time	05/31/2014 08:40:20 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	805	0	2015	Texas		1	42	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	806	0	1	01	01	H0332_806_0	4		1	06/02/2014	2015.01	06/02/2014 02:35:20 PM Central Daylight Time	05/31/2014 08:41:51 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential Retiree (HMO)	01	01		1			H0332	806	0	2015	Texas		1	1123	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2
H0332	807	0	1	01	01	H0332_807_0	4		1	06/02/2014	2015.01	06/02/2014 02:35:49 PM Central Daylight Time	05/31/2014 08:43:04 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	807	0	2015	Texas		1	3092	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	808	0	1	01	01	H0332_808_0	4		1	06/02/2014	2015.01	06/02/2014 02:36:17 PM Central Daylight Time	05/31/2014 08:44:56 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Essential+Choice Retiree (HMO)	01	01		1			H0332	808	0	2015	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273										(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537										2					2					2
H0332	809	0	1	01	01	H0332_809_0	4		1	06/02/2014	2015.01	06/02/2014 02:36:47 PM Central Daylight Time	05/31/2014 08:46:18 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx+Choice Retiree (HMO)	01	01		1			H0332	809	0	2015	Texas		1	76	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	810	0	1	01	01	H0332_810_0	4		1	06/02/2014	2015.01	06/02/2014 02:37:15 PM Central Daylight Time	05/31/2014 08:47:34 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	810	0	2015	Texas		1	16	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	811	0	1	01	01	H0332_811_0	4		1	06/02/2014	2015.01	06/02/2014 02:38:07 PM Central Daylight Time	05/31/2014 08:49:11 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	811	0	2015	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0332	812	0	1	01	01	H0332_812_0	4		1	06/02/2014	2015.01	06/02/2014 02:40:04 PM Central Daylight Time	05/31/2014 08:50:43 AM Central Daylight Time				06/02/2014 03:45:08 PM Central Daylight Time	KS PLAN ADMINISTRATORS, LLC	KelseyCare Advantage	www.kelseycareadvantage.com	KelseyCare Advantage Rx Retiree (HMO)	01	01		1			H0332	812	0	2015	Texas		1	9	2			2							www.Kelseycareadvantage.com	www.kelseycareadvantage.com	www.kelseycareadvantage.com	(866)535-8343		(713)442-2273		(800)663-7146		(713)442-2273		(866)535-8343		(713)442-2273		(866)535-8343		(713)442-2273		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		(866)302-9336		(713)442-9537		2					2					2
H0336	001	0	1	48	05	H0336_001_0	7		1	08/07/2014	2015.02	08/07/2014 09:37:17 AM Eastern Daylight Time					08/07/2014 09:43:14 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus Integrated H0336-001 (Medicare-Medicaid Plan)	05	48		1			H0336	001	0	2015	Chicago Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)787-3311		(800)787-3311		(800)833-2364		(800)833-2364		(800)787-3311		(800)787-3311		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	029	0	1	01	01	H0351_029_0	6	2	1	08/05/2014	2015.01	08/05/2014 03:47:24 PM Pacific Daylight Time	08/05/2014 06:41:06 PM Pacific Daylight Time	07/31/2014 07:12:26 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Amber (HMO SNP)	01	01		1			H0351	029	0	2015	Maricopa, AZ		2		2			1	3		1	4			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		2					2					2
H0351	030	0	1	01	01	H0351_030_0	3		1	07/14/2014	2015.01	07/14/2014 12:22:07 PM US Mountain Standard Time	05/31/2014 11:46:42 AM Pacific Daylight Time				07/15/2014 05:14:14 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Green (HMO)	01	01		1			H0351	030	0	2015	Maricopa, Pinal, Sta Cruz, Cochise		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757										2					2					2
H0351	035	0	1	01	01	H0351_035_0	4		1	08/05/2014	2015.01	08/05/2014 01:42:46 PM Pacific Daylight Time	08/05/2014 05:54:58 PM Pacific Daylight Time	07/31/2014 07:12:46 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 4 (HMO)	01	01		1			H0351	035	0	2015	Cochise, Pima, Santa Cruz		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	038	0	1	01	01	H0351_038_0	4		1	08/04/2014	2015.01	08/04/2014 10:59:03 AM Pacific Daylight Time	08/05/2014 12:52:34 PM Pacific Daylight Time	07/31/2014 07:13:02 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H0351	038	0	2015	Maricopa and Pinal Counties		2		2			1	4		1		00000000000000000100		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	040	0	1	01	01	H0351_040_0	3		1	08/04/2014	2015.01	08/04/2014 10:53:40 AM Pacific Daylight Time	08/05/2014 12:52:44 PM Pacific Daylight Time	07/31/2014 07:13:18 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0351	040	0	2015	Maricopa and Pinal  Counties, AZ		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	041	0	1	01	01	H0351_041_0	3		1	08/04/2014	2015.01	08/04/2014 10:56:49 AM Pacific Daylight Time	08/05/2014 12:52:54 PM Pacific Daylight Time	07/31/2014 07:50:06 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0351	041	0	2015	Pima County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	042	0	1	01	01	H0351_042_0	4		1	08/04/2014	2015.01	08/04/2014 11:02:00 AM Pacific Daylight Time	08/05/2014 12:53:04 PM Pacific Daylight Time	07/31/2014 07:52:48 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Jade Cardiovascular (HMO SNP)	01	01		1			H0351	042	0	2015	Maricopa and Pinal Counties		2		2			1	4		1		00010000000000000000		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	043	1	1	01	01	H0351_043_1	4		1	08/04/2014	2015.01	08/04/2014 11:07:27 AM Pacific Daylight Time	08/05/2014 12:53:14 PM Pacific Daylight Time	07/31/2014 07:14:22 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 1 (HMO)	01	01		1			H0351	043	1	2015	Maricopa, Pinal, Santa Cruz Counties, AZ	Maricopa and Pinal Counties, AZ	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	043	3	1	01	01	H0351_043_3	4		1	08/04/2014	2015.01	08/04/2014 11:09:58 AM Pacific Daylight Time	08/05/2014 12:53:24 PM Pacific Daylight Time	07/31/2014 07:14:52 PM Pacific Daylight Time			08/06/2014 12:56:10 PM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net Ruby 1 (HMO)	01	01		1			H0351	043	3	2015	Maricopa, Pinal, Santa Cruz Counties, AZ	Santa Cruz County, AZ	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0351	801	0	1	01	01	H0351_801_0	2		1	05/25/2014	2015.01	05/25/2014 10:41:39 AM Pacific Daylight Time	05/31/2014 11:46:42 AM Pacific Daylight Time				05/31/2014 11:54:02 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net EG (HMO)	01	01		1			H0351	801	0	2015	All AZ Counties		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0351	803	0	1	01	01	H0351_803_0	2		1	05/25/2014	2015.01	05/25/2014 10:41:46 AM Pacific Daylight Time	05/31/2014 11:46:42 AM Pacific Daylight Time				05/31/2014 11:54:02 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net EG (HMO)	01	01		1			H0351	803	0	2015	All AZ Counties		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930										(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0351	804	0	1	01	01	H0351_804_0	2		1	05/25/2014	2015.01	05/25/2014 10:41:52 AM Pacific Daylight Time	05/31/2014 11:46:42 AM Pacific Daylight Time				05/31/2014 11:54:02 AM Pacific Daylight Time	HEALTH NET OF ARIZONA, INC.	Health Net of Arizona, Inc.	www.healthnet.com/medicare	Health Net EG (HMO)	01	01		1			H0351	804	0	2015	All AZ Counties		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-7522		(800)977-7522		(800)333-3930		(800)333-3930		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		(800)977-6757		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0354	001	0	1	01	01	H0354_001_0	3		1	07/22/2014	2015.02	07/22/2014 09:28:15 AM Central Daylight Time	08/04/2014 02:17:33 PM Central Daylight Time	07/31/2014 03:48:27 PM Central Daylight Time			08/05/2014 09:44:38 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna HealthCare of Arizona	www.cignamedicare.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0354	001	0	2015	Maricopa County, Apache Junction and Queen Creek		2		2			2							www.cignamedicare.com	www.cignamedicare.com	www.cignamedicare.com	(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0354	021	0	1	01	01	H0354_021_0	4		1	07/22/2014	2015.02	07/22/2014 09:28:33 AM Central Daylight Time	07/24/2014 03:15:33 PM Central Daylight Time	07/31/2014 03:48:48 PM Central Daylight Time			08/05/2014 09:44:38 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna HealthCare of Arizona	www.cignamedicare.com	Cigna-HealthSpring Achieve Plus (HMO SNP)	01	01		1			H0354	021	0	2015	Maricopa County, Apache Junction and Queen Creek		2		2			1	4		1		00000000000000000100		www.cignamedicare.com	www.cignamedicare.com	www.cignamedicare.com	(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0354	023	0	1	01	01	H0354_023_0	4		1	07/22/2014	2015.02	07/22/2014 09:28:47 AM Central Daylight Time	05/26/2014 03:45:08 PM Central Daylight Time	07/31/2014 03:49:07 PM Central Daylight Time			08/05/2014 09:44:38 AM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna HealthCare of Arizona	www.cignamedicare.com	Cigna-HealthSpring Preferred Plus (HMO)	01	01		1			H0354	023	0	2015	Maricopa County, Apache Junction and Queen Creek		2		2			2							www.cignamedicare.com	www.cignamedicare.com	www.cignamedicare.com	(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0354	804	0	1	01	01	H0354_804_0	2		1	05/22/2014	2015.02	05/22/2014 02:35:16 PM US Mountain Standard Time	05/30/2014 08:09:06 AM Central Daylight Time				05/30/2014 12:58:01 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna HealthCare of Arizona	www.cignamedicare.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0354	804	0	2015	All Counties in Arizona		1	0	2			2							www.cignamedicare.com	www.cignamedicare.com	www.cignamedicare.com	(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011101011011110111001101000110	1	100001011011010000000011001	1					1
H0354	805	0	1	01	01	H0354_805_0	2		1	05/22/2014	2015.02	05/22/2014 02:36:36 PM US Mountain Standard Time	05/30/2014 08:09:34 AM Central Daylight Time				05/30/2014 12:58:01 PM Central Daylight Time	CIGNA HEALTHCARE OF ARIZONA, INC.	Cigna HealthCare of Arizona	www.cignamedicare.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0354	805	0	2015	All Counties in Arizona		1	0	2			2							www.cignamedicare.com	www.cignamedicare.com	www.cignamedicare.com	(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(800)627-7534		(800)627-7534		(800)592-9231		(800)592-9231		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011101011011110111001101000110	1	100001011011010000000011001	1					1
H0390	001	0	1	20	08	H0390_001_0	1		1	05/23/2014	2015.01	05/23/2014 01:09:13 PM Eastern Daylight Time		05/23/2014 12:35:53 PM Eastern Daylight Time			05/23/2014 01:12:15 PM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	theresesaggau@paceswmi.org	PACE of Southwest Michigan - Dual (PACE)	08	20		1			H0390	001	0	2015	PACE of Southwest Michigan - Dual		2		2			2								theresesaggau@paceswmi.org	www.seniorscript.com									(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324										(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324												
H0390	002	0	1	20	08	H0390_002_0	1		1	05/23/2014	2015.01	05/23/2014 01:10:38 PM Eastern Daylight Time		05/23/2014 12:35:53 PM Eastern Daylight Time			05/23/2014 01:12:15 PM Eastern Daylight Time	PACE OF SOUTHWEST MICHIGAN, INC.	PACE of Southwest Michigan	theresesaggau@paceswmi.org	PACE of Southwest Michigan - Medicare Only (PACE)	08	20		1			H0390	002	0	2015	PACE of Southwest Michigan - Medicare Only		2		2			2								theresesaggau@paceswmi.org	www.seniorscript.com									(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324										(855)243-8876		(269)408-4324		(855)243-8876		(269)408-4324												
H0408	002	0	1	02	01	H0408_002_0	5		1	08/04/2014	2015.02	08/04/2014 05:40:57 PM Central Daylight Time	08/11/2014 02:39:13 PM Central Daylight Time	07/31/2014 03:20:29 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H0408	002	0	2015	Nashville and Knoxville Metro areas		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0408	003	0	1	01	01	H0408_003_0	2		1	05/30/2014	2015.02	05/30/2014 04:17:01 PM Central Daylight Time	08/04/2014 02:41:45 PM Central Daylight Time	07/31/2014 03:20:37 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete (HMO)	01	01		1			H0408	003	0	2015	Select Counties in Tennessee		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0423	001	0	1	01	01	H0423_001_0	7	2	1	08/04/2014	2015.01	08/04/2014 04:45:10 PM Eastern Daylight Time	08/05/2014 05:22:08 PM Eastern Daylight Time	08/05/2014 05:22:04 PM Eastern Daylight Time			08/05/2014 05:25:35 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Advantage Plan (HMO SNP)	01	01		1			H0423	001	0	2015	NYC - The Bronx, Brooklyn, Manhattan, Queens		2	7215	2			1	3		1	2			www.metroplusmedicare.org	https://www.metroplus.org/CMSPages/GetFile.aspx?guid=3ee42e68-06ac-4431-8445-a77d6a8e117e	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2
H0423	002	0	1	01	01	H0423_002_0	7		1	05/30/2014	2015.01	05/30/2014 02:57:12 PM Eastern Daylight Time	08/06/2014 12:30:26 PM Eastern Daylight Time	08/06/2014 12:30:38 PM Eastern Daylight Time			08/06/2014 12:47:52 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Medicare Partnership in Care Plan (HMO SNP)	01	01		1			H0423	002	0	2015	NYC - The Bronx, Brooklyn, Manhattan, Queens		2	80	2			1	4		1		00000000001000000000		www.metroplusmedicare.org	https://www.metroplus.org/CMSPages/GetFile.aspx?guid=3ee42e68-06ac-4431-8445-a77d6a8e117e	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2
H0423	003	0	1	01	01	H0423_003_0	7	2	1	05/28/2014	2015.01	05/28/2014 05:01:57 PM Eastern Daylight Time	07/18/2014 09:51:51 AM Eastern Daylight Time	07/18/2014 09:51:52 AM Eastern Daylight Time			07/18/2014 03:23:45 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Select Plan (HMO SNP)	01	01		1			H0423	003	0	2015	NYC - The Bronx, Brooklyn, Manhattan, Queens		2	469	2			1	3		1	5			www.metroplusmedicare.org	https://www.metroplus.org/CMSPages/GetFile.aspx?guid=3ee42e68-06ac-4431-8445-a77d6a8e117e	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111110000010011010011111000000	1	111111111010011111010110000	1					1
H0423	004	0	1	01	01	H0423_004_0	6		1	05/31/2014	2015.01	05/31/2014 11:14:22 AM Eastern Daylight Time	08/06/2014 12:30:30 PM Eastern Daylight Time	08/06/2014 12:30:39 PM Eastern Daylight Time			08/06/2014 12:47:52 PM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus Platinum (HMO)	01	01		1			H0423	004	0	2015	NYC - The Bronx, Brooklyn, Manhattan, Queens		2	1935	2			2							www.metroplusmedicare.org	https://www.metroplus.org/CMSPages/GetFile.aspx?guid=3ee42e68-06ac-4431-8445-a77d6a8e117e	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2
H0435	001	0	1	01	01	H0435_001_0	6		1	07/25/2014	2015.01	07/25/2014 09:48:51 AM Central Daylight Time	07/17/2014 01:16:26 PM Central Daylight Time				07/25/2014 09:59:09 AM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth-medicare.com	GlobalHealth Medicare Option 1 (HMO)	01	01		1			H0435	001	0	2015	Oklahoma		2	31	2			2							http://globalhealth-medicare.com/search.aspx	www.globalhealth-medicare.com/medicare_materials.aspx	http://globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774										(711)-		(711)-		(711)-		(711)-										2					2					2
H0435	002	0	1	01	01	H0435_002_0	10		1	07/25/2014	2015.01	07/25/2014 09:48:32 AM Central Daylight Time	08/05/2014 02:27:10 PM Central Daylight Time	08/04/2014 04:30:32 PM Central Daylight Time			08/05/2014 02:32:42 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth-medicare.com	GlobalHealth Medicare Option 2 (HMO)	01	01		1			H0435	002	0	2015	Oklahoma		2	207	2			2							http://globalhealth-medicare.com/search.aspx	www.globalhealth-medicare.com/medicare_materials.aspx	http://globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0435	003	0	1	01	01	H0435_003_0	8		1	07/25/2014	2015.01	07/25/2014 09:48:21 AM Central Daylight Time	08/04/2014 04:30:38 PM Central Daylight Time	08/04/2014 04:30:38 PM Central Daylight Time			08/04/2014 04:43:34 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth-medicare.com	GlobalHealth Medicare Option 3 (HMO)	01	01		1			H0435	003	0	2015	Oklahoma		2	196	2			2							http://globalhealth-medicare.com/search.aspx	www.globalhealth-medicare.com/medicare_materials.aspx	http://globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0435	004	0	1	01	01	H0435_004_0	7		1	08/04/2014	2015.01	08/04/2014 01:37:15 PM Central Daylight Time	08/04/2014 04:30:40 PM Central Daylight Time	08/04/2014 04:30:41 PM Central Daylight Time			08/04/2014 04:43:34 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth-medicare.com	GlobalHealth Medicare Option 4 (HMO)	01	01		1			H0435	004	0	2015	Oklahoma		2	329	2			2							http://globalhealth-medicare.com/search.aspx	http://www.globalhealth.com/medicare_materials.aspx	http://globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0435	005	0	1	01	01	H0435_005_0	7		1	08/04/2014	2015.01	08/04/2014 01:38:08 PM Central Daylight Time	08/04/2014 04:30:45 PM Central Daylight Time	08/04/2014 04:30:46 PM Central Daylight Time			08/04/2014 04:43:34 PM Central Daylight Time	GLOBALHEALTH, INC.	GLOBALHEALTH MEDICARE	www.globalhealth-medicare.com	GlobalHealth Medicare Option 5 (HMO)	01	01		1			H0435	005	0	2015	Oklahoma		2	749	2			2							http://globalhealth-medicare.com/search.aspx	http://www.globalhealth.com/medicare_materials.aspx	http://globalhealth-medicare.com/search.aspx	(877)280-5774		(405)280-5774		(877)280-5774		(405)280-5774		(866)844-0151		(866)844-0151		(877)280-5774		(405)280-5774		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0439	001	0	1	01	01	H0439_001_0	4		1	07/16/2014	2015.02	07/16/2014 02:33:56 PM Central Daylight Time	05/29/2014 07:16:41 PM Central Daylight Time	07/31/2014 03:45:49 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H0439	001	0	2015	Georgia		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0439	002	0	1	01	01	H0439_002_0	4	2	1	07/16/2014	2015.02	07/16/2014 02:34:08 PM Central Daylight Time	08/04/2014 01:25:10 PM Central Daylight Time	07/31/2014 03:45:59 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H0439	002	0	2015	Georgia		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0439	801	0	1	01	01	H0439_801_0	1		1	05/23/2014	2015.02	05/23/2014 08:46:46 AM Central Daylight Time	05/29/2014 07:17:22 PM Central Daylight Time				05/29/2014 11:20:07 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H0439	801	0	2015	Georgia		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(877)357-1685		(877)357-1685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H0439	802	0	1	02	01	H0439_802_0	1		1	05/14/2014	2015.02	05/14/2014 10:14:03 AM Central Daylight Time	05/29/2014 07:17:42 PM Central Daylight Time				05/29/2014 11:20:07 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H0439	802	0	2015	Georgia		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(877)357-1685		(877)357-1685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H0439	803	0	1	01	01	H0439_803_0	1		1	05/14/2014	2015.02	05/14/2014 10:14:23 AM Central Daylight Time	05/29/2014 07:18:02 PM Central Daylight Time				05/29/2014 11:20:07 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H0439	803	0	2015	Georgia		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(877)357-1685		(877)357-1685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H0439	804	0	1	02	01	H0439_804_0	1		1	05/14/2014	2015.02	05/14/2014 10:14:44 AM Central Daylight Time	05/29/2014 07:18:21 PM Central Daylight Time				05/29/2014 11:20:07 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H0439	804	0	2015	Georgia		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(877)357-1685		(877)357-1685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H0439	805	0	1	01	01	H0439_805_0	1		1	05/23/2014	2015.02	05/23/2014 08:46:03 AM Central Daylight Time	05/29/2014 07:18:42 PM Central Daylight Time				05/29/2014 11:20:07 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H0439	805	0	2015	Georgia		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H0439	806	0	1	02	01	H0439_806_0	1		1	05/23/2014	2015.02	05/23/2014 09:25:52 AM Central Daylight Time	05/29/2014 07:19:02 PM Central Daylight Time				05/29/2014 11:20:07 PM Central Daylight Time	CIGNA HEALTHCARE OF GEORGIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H0439	806	0	2015	Georgia		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H0477	001	0	1	20	08	H0477_001_0	1		1	05/28/2014	2015.01	05/28/2014 02:04:41 PM Eastern Daylight Time		05/28/2014 01:32:00 PM Eastern Daylight Time			05/28/2014 02:08:24 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	n/a	Serenity PACE Dual (PACE)	08	20		1			H0477	001	0	2015	Serenity Pace Dual		2		2			2								n/a	n/a									(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772										(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772												
H0477	002	0	1	20	08	H0477_002_0	1		1	05/28/2014	2015.01	05/28/2014 02:05:19 PM Eastern Daylight Time		05/28/2014 01:32:00 PM Eastern Daylight Time			05/28/2014 02:08:24 PM Eastern Daylight Time	SERENITY CARE, INC.	Serenity Care PACE	n/a	Serenity PACE Medicare only (PACE)	08	20		1			H0477	002	0	2015	Serenity PACE Medicare only		2		2			2								n/a	n/a									(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772										(413)627-9772		(413)627-9772		(413)627-9772		(413)627-9772												
H0480	001	0	1	48	05	H0480_001_0	3		1	09/11/2014	2015.01	09/11/2014 05:58:03 PM Eastern Daylight Time					09/11/2014 06:31:18 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian Complete	www.medicaremeridian.com	Meridian Complete (Medicare-Medicaid Plan)	05	48		1			H0480	001	0	2015	Southwestern Michigan		2	10000	2			2							www.medicaremeridian.com	www.mhplan.com	www.mhplan.com	(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(877)902-6784		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0490	004	0	1	01	01	H0490_004_0	8	2	1	08/05/2014	2015.01	08/05/2014 08:33:08 AM Pacific Daylight Time	08/05/2014 11:09:00 AM Pacific Daylight Time	08/05/2014 09:35:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H0490	004	0	2015	Ohio		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)472-4584		(866)472-4584		(866)403-8293		(866)403-8293		(866)472-4584		(866)472-4584		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	015	0	1	01	01	H0504_015_0	6		1	08/06/2014	2015.01	08/06/2014 10:08:10 AM Pacific Daylight Time	08/06/2014 09:59:06 AM Pacific Daylight Time	08/06/2014 09:15:46 AM Pacific Daylight Time			08/06/2014 02:40:11 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	015	0	2015	Los Angeles (Partial)/Orange Counties		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	017	0	1	01	01	H0504_017_0	5		1	08/06/2014	2015.01	08/06/2014 10:26:06 AM Pacific Daylight Time	08/06/2014 10:00:59 AM Pacific Daylight Time	08/06/2014 09:19:21 AM Pacific Daylight Time			08/06/2014 02:52:22 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	017	0	2015	San Bernardino County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	021	0	1	01	01	H0504_021_0	7		1	08/06/2014	2015.01	08/06/2014 09:07:56 AM Pacific Daylight Time	08/06/2014 10:08:06 AM Pacific Daylight Time	08/06/2014 09:20:04 AM Pacific Daylight Time			08/06/2014 02:56:32 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus Choice Plan (HMO)	01	01		1			H0504	021	0	2015	Los Angeles (Partial)/Orange Counties CP		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	026	0	1	01	01	H0504_026_0	5		1	08/06/2014	2015.01	08/06/2014 11:53:13 AM Pacific Daylight Time	08/06/2014 10:11:13 AM Pacific Daylight Time	08/06/2014 09:20:42 AM Pacific Daylight Time			08/06/2014 03:02:10 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	026	0	2015	Riverside County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	027	0	1	01	01	H0504_027_0	5		1	08/06/2014	2015.01	08/06/2014 11:54:06 AM Pacific Daylight Time	08/06/2014 10:17:54 AM Pacific Daylight Time	08/06/2014 09:21:27 AM Pacific Daylight Time			08/06/2014 03:06:46 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	027	0	2015	Sacramento County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	028	0	1	01	01	H0504_028_0	5		1	08/06/2014	2015.01	08/06/2014 09:48:20 AM Pacific Daylight Time	08/06/2014 10:21:59 AM Pacific Daylight Time	08/06/2014 09:22:21 AM Pacific Daylight Time			08/06/2014 03:11:19 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	028	0	2015	San Diego County		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	029	0	1	01	01	H0504_029_0	5		1	08/06/2014	2015.01	08/06/2014 09:53:27 AM Pacific Daylight Time	08/06/2014 10:25:18 AM Pacific Daylight Time	08/06/2014 09:22:58 AM Pacific Daylight Time			08/06/2014 03:15:37 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	029	0	2015	Ventura County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	030	0	1	01	01	H0504_030_0	6		1	08/06/2014	2015.01	08/06/2014 10:30:02 AM Pacific Daylight Time	08/06/2014 10:28:32 AM Pacific Daylight Time	08/06/2014 09:23:39 AM Pacific Daylight Time			08/06/2014 03:20:52 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	030	0	2015	Contra Costa County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	031	0	1	01	01	H0504_031_0	5		1	08/06/2014	2015.01	08/06/2014 10:35:43 AM Pacific Daylight Time	08/06/2014 10:31:48 AM Pacific Daylight Time	08/06/2014 09:25:43 AM Pacific Daylight Time			08/06/2014 03:25:18 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	031	0	2015	Fresno County		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	032	0	1	01	01	H0504_032_0	5		1	08/06/2014	2015.01	08/06/2014 02:48:01 PM Pacific Daylight Time	08/06/2014 10:34:50 AM Pacific Daylight Time	08/06/2014 09:27:45 AM Pacific Daylight Time			08/06/2014 03:29:51 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield 65 Plus (HMO)	01	01		1			H0504	032	0	2015	Santa Clara County (Partial)		2		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0504	803	0	1	01	01	H0504_803_0	5		1	05/22/2014	2015.01	05/22/2014 04:00:17 PM Pacific Daylight Time	06/04/2014 10:16:03 AM Pacific Daylight Time				06/09/2014 09:35:45 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com	Blue Shield 65 Plus (HMO)	01	01		1			H0504	803	0	2015	MA-PD Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	2					2
H0504	804	0	1	01	01	H0504_804_0	5		1	05/22/2014	2015.01	05/22/2014 04:07:25 PM Pacific Daylight Time	06/04/2014 10:18:21 AM Pacific Daylight Time				06/09/2014 09:38:00 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com	Blue Shield 65 Plus (HMO)	01	01		1			H0504	804	0	2015	MA-PD Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(800)776-4466		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	2					2
H0504	805	0	1	01	01	H0504_805_0	5		1	05/22/2014	2015.01	05/22/2014 04:27:36 PM Pacific Daylight Time	06/04/2014 10:21:22 AM Pacific Daylight Time				06/09/2014 09:39:37 AM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com	Blue Shield 65 Plus (HMO)	01	01		1			H0504	805	0	2015	MA-Only Employer Group Plan		1		2			2							www.blueshieldca.com/findaprovider	www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy	(800)776-4466		(800)776-4466		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	2					2
H0523	002	0	1	01	01	H0523_002_0	5		1	07/31/2014	2015.01	07/31/2014 10:46:48 AM Eastern Daylight Time	08/05/2014 09:55:26 AM Eastern Daylight Time	07/31/2014 05:19:41 PM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	002	0	2015	Los Angeles and Orange Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	022	0	1	01	01	H0523_022_0	5		1	08/04/2014	2015.01	08/04/2014 10:00:55 AM Eastern Daylight Time	08/05/2014 11:28:28 AM Eastern Daylight Time	07/31/2014 05:19:53 PM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	022	0	2015	Riverside and San Bernardino Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	031	0	1	01	01	H0523_031_0	5		1	08/04/2014	2015.01	08/04/2014 10:01:17 AM Eastern Daylight Time	08/08/2014 10:33:11 AM Eastern Daylight Time	07/31/2014 05:20:03 PM Eastern Daylight Time			08/08/2014 11:16:21 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	031	0	2015	Kern County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	052	0	1	01	01	H0523_052_0	5		1	08/02/2014	2015.01	08/02/2014 08:43:15 PM Eastern Daylight Time	08/08/2014 10:43:18 AM Eastern Daylight Time	07/31/2014 05:20:14 PM Eastern Daylight Time			08/08/2014 11:16:21 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H0523	052	0	2015	San Diego County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	060	0	1	01	01	H0523_060_0	4		1	08/05/2014	2015.01	08/05/2014 07:44:59 AM Eastern Daylight Time	08/05/2014 11:33:56 AM Eastern Daylight Time	07/31/2014 05:20:24 PM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	060	0	2015	Orange County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	061	0	1	01	01	H0523_061_0	3		1	08/04/2014	2015.01	08/04/2014 10:00:48 AM Eastern Daylight Time	08/05/2014 11:36:22 AM Eastern Daylight Time	07/31/2014 05:20:35 PM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	061	0	2015	Los Angeles county		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	063	0	1	01	01	H0523_063_0	4		1	08/04/2014	2015.01	08/04/2014 10:00:06 AM Eastern Daylight Time	08/08/2014 10:45:56 AM Eastern Daylight Time	07/31/2014 05:20:56 PM Eastern Daylight Time			08/08/2014 11:16:21 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H0523	063	0	2015	San Bernadino county		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0523	801	0	1	01	01	H0523_801_0	3		1	05/19/2014	2015.01	05/19/2014 10:03:21 PM Eastern Daylight Time	07/16/2014 09:47:36 AM Eastern Daylight Time				07/16/2014 09:56:45 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0523	801	0	2015	California		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H0523	805	0	1	01	01	H0523_805_0	2		1	05/19/2014	2015.01	05/19/2014 10:21:52 PM Eastern Daylight Time	07/16/2014 09:46:53 AM Eastern Daylight Time				07/16/2014 09:56:45 AM Eastern Daylight Time	AETNA HEALTH OF CALIFORNIA INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H0523	805	0	2015	California		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H0524	002	0	2	01	01	H0524_002_0	9		1	07/25/2014	2015.01	07/25/2014 08:49:13 AM Pacific Daylight Time	08/06/2014 08:50:51 AM Pacific Daylight Time	08/04/2014 01:35:48 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only South (HMO)	01	01		2	1		H0524	002	0	2015	Part B Only Southern California Area		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	003	0	1	01	01	H0524_003_0	8		1	08/05/2014	2015.01	08/05/2014 09:32:25 AM Pacific Daylight Time	08/06/2014 08:55:08 AM Pacific Daylight Time	08/01/2014 04:59:26 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage LA, Orange Co. (HMO)	01	01		1			H0524	003	0	2015	Los Angeles and Orange Counties Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	008	0	1	01	01	H0524_008_0	8		1	07/23/2014	2015.01	07/23/2014 06:33:52 PM Pacific Daylight Time	08/06/2014 08:53:04 AM Pacific Daylight Time	08/01/2014 05:05:58 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Solano (HMO)	01	01		1			H0524	008	0	2015	Solano County Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	010	0	2	01	01	H0524_010_0	9		1	07/23/2014	2015.01	07/23/2014 06:34:02 PM Pacific Daylight Time	08/06/2014 08:59:09 AM Pacific Daylight Time	08/01/2014 04:41:41 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage B Only North (HMO)	01	01		2	1		H0524	010	0	2015	Part B Only Northern California Area		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	013	0	1	01	01	H0524_013_0	11		1	08/05/2014	2015.01	08/05/2014 08:19:52 AM Pacific Daylight Time	08/06/2014 08:56:09 AM Pacific Daylight Time	08/01/2014 05:09:59 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO)	01	01		1			H0524	013	0	2015	Greater Sac and Sonoma County Plan - Enhanced		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	015	0	1	01	01	H0524_015_0	9		1	08/05/2014	2015.01	08/05/2014 09:32:43 AM Pacific Daylight Time	08/06/2014 08:57:20 AM Pacific Daylight Time	08/01/2014 05:13:35 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Inland Empire (HMO)	01	01		1			H0524	015	0	2015	Inland Empire Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	029	0	1	01	01	H0524_029_0	11	2	1	08/12/2014	2015.01	08/12/2014 08:26:20 AM Pacific Daylight Time	08/06/2014 09:00:03 AM Pacific Daylight Time	08/04/2014 09:51:03 AM Pacific Daylight Time			08/12/2014 09:08:16 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan South (HMO SNP)	01	01		1			H0524	029	0	2015	Southern California Plan		2		2			1	3		1	3		2	kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	030	0	1	01	01	H0524_030_0	11	2	1	08/12/2014	2015.01	08/12/2014 08:26:41 AM Pacific Daylight Time	08/06/2014 08:57:46 AM Pacific Daylight Time	08/04/2014 09:50:04 AM Pacific Daylight Time			08/12/2014 09:08:16 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medi-Cal Plan North (HMO SNP)	01	01		1			H0524	030	0	2015	Northern California Plan		2		2			1	3		1	3		2	kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	031	0	1	01	01	H0524_031_0	9		1	08/05/2014	2015.01	08/05/2014 08:25:56 AM Pacific Daylight Time	08/06/2014 09:00:16 AM Pacific Daylight Time	08/01/2014 05:29:18 PM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Marin San Mateo (HMO)	01	01		1			H0524	031	0	2015	Marin and San Mateo Counties Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	032	0	1	01	01	H0524_032_0	8		1	07/23/2014	2015.01	07/23/2014 06:35:07 PM Pacific Daylight Time	08/06/2014 09:02:22 AM Pacific Daylight Time	08/04/2014 08:44:37 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO)	01	01		1			H0524	032	0	2015	Alameda, Napa, and SF Counties Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	033	0	1	01	01	H0524_033_0	8		1	07/23/2014	2015.01	07/23/2014 06:35:18 PM Pacific Daylight Time	08/06/2014 09:04:30 AM Pacific Daylight Time	08/04/2014 08:48:35 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Contra Costa (HMO)	01	01		1			H0524	033	0	2015	Contra Costa County Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	034	0	1	01	01	H0524_034_0	8		1	08/05/2014	2015.01	08/05/2014 09:32:58 AM Pacific Daylight Time	08/06/2014 09:06:02 AM Pacific Daylight Time	08/04/2014 08:51:20 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Ventura (HMO)	01	01		1			H0524	034	0	2015	Ventura County Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	035	0	1	01	01	H0524_035_0	8		1	07/23/2014	2015.01	07/23/2014 06:35:37 PM Pacific Daylight Time	08/06/2014 09:01:45 AM Pacific Daylight Time	08/04/2014 08:53:56 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Kern (HMO)	01	01		1			H0524	035	0	2015	Kern County Plan - Enhanced		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	036	0	1	01	01	H0524_036_0	8		1	08/05/2014	2015.01	08/05/2014 09:33:25 AM Pacific Daylight Time	08/06/2014 09:04:58 AM Pacific Daylight Time	08/04/2014 08:56:31 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Kern (HMO)	01	01		1			H0524	036	0	2015	Kern County Plan - Basic		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	037	0	1	01	01	H0524_037_0	9		1	08/05/2014	2015.01	08/05/2014 09:33:42 AM Pacific Daylight Time	08/06/2014 09:03:09 AM Pacific Daylight Time	08/04/2014 08:59:14 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage San Diego (HMO)	01	01		1			H0524	037	0	2015	San Diego County Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	038	0	1	01	01	H0524_038_0	8		1	07/23/2014	2015.01	07/23/2014 06:36:02 PM Pacific Daylight Time	08/06/2014 09:06:50 AM Pacific Daylight Time	08/04/2014 09:01:50 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Fresno (HMO)	01	01		1			H0524	038	0	2015	Greater Fresno Area Plan - Enhanced		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	039	0	1	01	01	H0524_039_0	8		1	07/23/2014	2015.01	07/23/2014 06:36:10 PM Pacific Daylight Time	08/06/2014 09:01:38 AM Pacific Daylight Time	08/04/2014 09:04:34 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Santa Clara (HMO)	01	01		1			H0524	039	0	2015	Santa Clara County Plan		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	040	0	1	01	01	H0524_040_0	8		1	07/23/2014	2015.01	07/23/2014 06:36:17 PM Pacific Daylight Time	08/06/2014 08:59:57 AM Pacific Daylight Time	08/04/2014 09:12:01 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced Stanis (HMO)	01	01		1			H0524	040	0	2015	Stanislaus County Plan - Enhanced		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	041	0	1	01	01	H0524_041_0	8		1	08/05/2014	2015.01	08/05/2014 08:32:42 AM Pacific Daylight Time	08/06/2014 08:56:56 AM Pacific Daylight Time	08/04/2014 09:16:12 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Stanis (HMO)	01	01		1			H0524	041	0	2015	Stanislaus County Plan - Basic		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	042	0	1	01	01	H0524_042_0	8		1	07/23/2014	2015.01	07/23/2014 06:36:36 PM Pacific Daylight Time	08/06/2014 08:58:25 AM Pacific Daylight Time	08/04/2014 09:21:50 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced SnJoaq (HMO)	01	01		1			H0524	042	0	2015	San Joaquin County Plan - Enhanced		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	043	0	1	01	01	H0524_043_0	8		1	08/05/2014	2015.01	08/05/2014 08:37:59 AM Pacific Daylight Time	08/06/2014 08:55:18 AM Pacific Daylight Time	08/04/2014 09:27:10 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)	01	01		1			H0524	043	0	2015	San Joaquin County Plan - Basic		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	046	0	1	01	01	H0524_046_0	8		1	08/05/2014	2015.01	08/05/2014 09:32:05 AM Pacific Daylight Time	08/06/2014 08:52:15 AM Pacific Daylight Time	08/04/2014 09:30:09 AM Pacific Daylight Time			08/06/2014 08:00:32 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic Fresno (HMO)	01	01		1			H0524	046	0	2015	Greater Fresno Area Plan - Basic		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	051	0	1	01	01	H0524_051_0	11		1	08/08/2014	2015.01	08/08/2014 09:32:15 AM Pacific Daylight Time	08/09/2014 07:18:07 PM Pacific Daylight Time	08/01/2014 04:48:10 PM Pacific Daylight Time			08/10/2014 08:46:48 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO)	01	01		1			H0524	051	0	2015	Greater Sac and Sonoma County Plan - Basic		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0524	801	0	1	01	01	H0524_801_0	4		1	05/23/2014	2015.01	05/23/2014 11:30:15 AM Pacific Daylight Time	07/03/2014 02:03:33 PM Pacific Daylight Time				07/14/2014 01:35:08 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	801	0	2015	Southern California Group Part A B		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	010000000000000000000000001110000000	1	100000011011010000000001100	1					2
H0524	802	0	1	01	01	H0524_802_0	4		1	05/15/2014	2015.01	05/15/2014 08:56:22 AM Pacific Daylight Time	07/03/2014 02:04:47 PM Pacific Daylight Time				07/14/2014 01:35:08 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	802	0	2015	Northern California Group Part A B		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	010000000000000000000000001110000000	1	100000111011010000000001100	1					2
H0524	803	0	2	01	01	H0524_803_0	5		1	05/15/2014	2015.01	05/15/2014 08:56:33 AM Pacific Daylight Time	07/03/2014 02:05:38 PM Pacific Daylight Time				07/15/2014 08:12:30 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	803	0	2015	Southern California Group B Only		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	010000000000000000000000001110000000	1	100000011011010000000001100	1					2
H0524	804	0	2	01	01	H0524_804_0	5		1	05/15/2014	2015.01	05/15/2014 08:56:48 AM Pacific Daylight Time	07/03/2014 02:07:18 PM Pacific Daylight Time				07/14/2014 01:48:38 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	804	0	2015	Northern California Group B Only		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238										(711)-		(711)-		(711)-		(711)-										1	1	010000000000000000000000001110000000	1	100000111011010000000001100	1					2
H0524	805	0	1	01	01	H0524_805_0	5		1	05/15/2014	2015.01	05/15/2014 08:56:57 AM Pacific Daylight Time	07/16/2014 05:44:52 PM Pacific Daylight Time				07/22/2014 06:07:18 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	805	0	2015	Southern California Group Part A B Part D		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000011011010000000001100	1					2
H0524	806	0	1	01	01	H0524_806_0	4		1	05/15/2014	2015.01	05/15/2014 08:57:06 AM Pacific Daylight Time	07/03/2014 02:12:08 PM Pacific Daylight Time				07/14/2014 01:35:08 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H0524	806	0	2015	Northern California Group Part A B Part D		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000111011010000000001100	1					2
H0524	807	0	2	01	01	H0524_807_0	4		1	05/15/2014	2015.01	05/15/2014 02:59:15 PM Pacific Daylight Time	07/03/2014 02:12:53 PM Pacific Daylight Time				07/14/2014 01:48:38 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	807	0	2015	Southern California Group Part B only  Part D		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000011011010000000001100	1					2
H0524	808	0	2	01	01	H0524_808_0	4		1	05/15/2014	2015.01	05/15/2014 08:57:24 AM Pacific Daylight Time	07/03/2014 02:14:08 PM Pacific Daylight Time				07/14/2014 01:48:38 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		2	1		H0524	808	0	2015	Northern California Group Part B only Part D		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000111011010000000001100	1					2
H0524	809	0	1	01	01	H0524_809_0	5		1	05/15/2014	2015.01	05/15/2014 08:57:34 AM Pacific Daylight Time	07/03/2014 02:15:56 PM Pacific Daylight Time				07/17/2014 09:19:28 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	809	0	2015	Southern California Plan		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000011011010000000001100	1					2
H0524	810	0	1	01	01	H0524_810_0	5		1	05/15/2014	2015.01	05/15/2014 08:57:44 AM Pacific Daylight Time	07/03/2014 02:17:54 PM Pacific Daylight Time				07/17/2014 09:19:28 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB with D (HMO)	01	01		1			H0524	810	0	2015	Northern California Plan		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000111011010000000001100	1					2
H0524	811	0	2	01	01	H0524_811_0	6		1	05/15/2014	2015.01	05/15/2014 08:57:58 AM Pacific Daylight Time	07/03/2014 02:19:01 PM Pacific Daylight Time				07/14/2014 01:48:38 PM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	811	0	2015	Southern California Plan		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000011011010000000001100	1					2
H0524	812	0	2	01	01	H0524_812_0	5		1	05/15/2014	2015.01	05/15/2014 08:58:08 AM Pacific Daylight Time	07/03/2014 02:20:08 PM Pacific Daylight Time				07/15/2014 08:12:30 AM Pacific Daylight Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part B Only with D (HMO)	01	01		2	1		H0524	812	0	2015	Northern California Plan		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(800)443-0815		(800)443-0815		(800)777-1238		(800)777-1238		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010000000000000000000000001110000000	1	100000111011010000000001100	1					2
H0542	001	0	1	20	08	H0542_001_0	1		1	05/21/2014	2015.01	05/21/2014 09:30:07 AM Pacific Daylight Time		05/21/2014 08:10:24 AM Pacific Daylight Time			05/21/2014 09:32:53 AM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	08	20		1			H0542	001	0	2015	Los Angeles County		2		2			2								http://www.altamed.org/	http://www.altamed.org/									(877)462-2582		(323)728-0411		(877)462-2582		(323)728-0411										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922												
H0542	002	0	1	20	08	H0542_002_0	1		1	05/21/2014	2015.01	05/21/2014 09:30:41 AM Pacific Daylight Time		05/21/2014 08:26:24 AM Pacific Daylight Time			05/21/2014 09:32:53 AM Pacific Daylight Time	ALTAMED HEALTH SERVICES CORPORATION	AltaMed Health Services Corporation	www.altamed.org	AltaMed Health Services Corporation (PACE)	08	20		1			H0542	002	0	2015	Los Angeles County		2		2			2								http://www.altamed.org/	http://www.altamed.org/									(877)462-2582		(323)728-0411		(877)462-2582		(323)728-0411										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922												
H0543	001	0	1	01	01	H0543_001_0	2		1	05/30/2014	2015.02	05/30/2014 04:10:05 PM Central Daylight Time	08/04/2014 02:35:27 PM Central Daylight Time	07/31/2014 03:20:46 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	001	0	2015	Los Angeles county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	004	0	1	01	01	H0543_004_0	2		1	05/30/2014	2015.02	05/30/2014 04:10:23 PM Central Daylight Time	08/04/2014 02:35:55 PM Central Daylight Time	07/31/2014 03:20:55 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	004	0	2015	Orange county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	007	0	1	01	01	H0543_007_0	2		1	05/30/2014	2015.02	05/30/2014 04:10:37 PM Central Daylight Time	08/04/2014 02:36:22 PM Central Daylight Time	07/31/2014 03:21:04 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	007	0	2015	Riverside and San Bernardino counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	013	0	1	01	01	H0543_013_0	2		1	05/30/2014	2015.02	05/30/2014 04:10:57 PM Central Daylight Time	08/04/2014 02:36:50 PM Central Daylight Time	07/31/2014 03:21:13 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Value (HMO)	01	01		1			H0543	013	0	2015	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	019	0	1	01	01	H0543_019_0	2		1	05/30/2014	2015.02	05/30/2014 04:11:10 PM Central Daylight Time	08/04/2014 02:37:19 PM Central Daylight Time	07/31/2014 03:21:21 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	019	0	2015	Kern county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	022	0	1	01	01	H0543_022_0	2		1	05/30/2014	2015.02	05/30/2014 04:11:26 PM Central Daylight Time	08/04/2014 02:37:47 PM Central Daylight Time	07/31/2014 03:21:29 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	022	0	2015	Ventura county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	028	0	1	01	01	H0543_028_0	2		1	05/30/2014	2015.02	05/30/2014 04:11:46 PM Central Daylight Time	08/04/2014 02:38:14 PM Central Daylight Time	07/31/2014 03:21:38 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	028	0	2015	San Mateo county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	029	0	1	01	01	H0543_029_0	2		1	05/30/2014	2015.02	05/30/2014 04:12:00 PM Central Daylight Time	08/04/2014 02:38:41 PM Central Daylight Time	07/31/2014 03:21:46 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	029	0	2015	Santa Clara county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	032	0	1	01	01	H0543_032_0	2		1	05/30/2014	2015.02	05/30/2014 04:12:16 PM Central Daylight Time	08/04/2014 02:39:07 PM Central Daylight Time	07/31/2014 03:21:54 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	032	0	2015	Santa Barbara and San Luis Obispo counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	035	0	1	01	01	H0543_035_0	2		1	05/30/2014	2015.02	05/30/2014 04:12:31 PM Central Daylight Time	08/04/2014 02:39:33 PM Central Daylight Time	07/31/2014 03:22:02 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	035	0	2015	Fresno and Madera counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	036	0	1	01	01	H0543_036_0	3		1	06/02/2014	2015.02	06/02/2014 04:47:40 PM Central Daylight Time	08/04/2014 02:40:01 PM Central Daylight Time	07/31/2014 03:22:09 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	036	0	2015	Stanislaus county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	060	0	1	01	01	H0543_060_0	2		1	05/30/2014	2015.02	05/30/2014 04:13:02 PM Central Daylight Time	08/04/2014 02:40:27 PM Central Daylight Time	07/31/2014 03:22:18 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Premier (HMO)	01	01		1			H0543	060	0	2015	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	070	0	1	01	01	H0543_070_0	2		1	05/30/2014	2015.02	05/30/2014 04:13:25 PM Central Daylight Time	08/04/2014 02:40:54 PM Central Daylight Time	07/31/2014 03:22:27 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	070	0	2015	Alameda and Contra Costa counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	086	0	1	01	01	H0543_086_0	2		1	05/30/2014	2015.02	05/30/2014 04:13:38 PM Central Daylight Time	08/04/2014 02:41:21 PM Central Daylight Time	07/31/2014 03:22:35 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	086	0	2015	Nevada county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	089	0	1	01	01	H0543_089_0	2		1	05/30/2014	2015.02	05/30/2014 04:13:58 PM Central Daylight Time	08/04/2014 02:41:48 PM Central Daylight Time	07/31/2014 03:22:44 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0543	089	0	2015	Placer, Sacramento, and Yolo counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	121	0	1	01	01	H0543_121_0	1		1	05/30/2014	2015.02	05/30/2014 11:59:12 AM Central Daylight Time	05/30/2014 05:12:13 PM Central Daylight Time				05/31/2014 10:01:43 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0543	121	0	2015	Kern,LA,Orange,Riverside,San Bernardino,San Diego		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H0543	138	0	1	01	01	H0543_138_0	2		1	05/30/2014	2015.02	05/30/2014 04:14:16 PM Central Daylight Time	08/04/2014 02:42:16 PM Central Daylight Time	07/31/2014 03:22:52 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	138	0	2015	Orange county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	140	0	1	01	01	H0543_140_0	2		1	05/30/2014	2015.02	05/30/2014 04:14:32 PM Central Daylight Time	08/04/2014 02:42:43 PM Central Daylight Time	07/31/2014 03:23:01 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	140	0	2015	Amador, El Dorado, Mendocino,Merced,Shasta,Tulare		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	144	0	1	01	01	H0543_144_0	2		1	05/30/2014	2015.02	05/30/2014 04:14:52 PM Central Daylight Time	08/04/2014 02:43:11 PM Central Daylight Time	07/31/2014 03:23:09 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	144	0	2015	Riverside and San Bernardino counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	145	0	1	01	01	H0543_145_0	2		1	05/30/2014	2015.02	05/30/2014 04:15:07 PM Central Daylight Time	08/04/2014 02:43:38 PM Central Daylight Time	07/31/2014 03:23:17 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	Sharp SecureHorizons Plan by UnitedHealthcare (HMO)	01	01		1			H0543	145	0	2015	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(800)950-9355		(800)950-9355		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	146	0	1	01	01	H0543_146_0	2		1	05/30/2014	2015.02	05/30/2014 04:15:25 PM Central Daylight Time	08/04/2014 02:44:05 PM Central Daylight Time	07/31/2014 03:23:25 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	146	0	2015	Placer, Sacramento, and Yolo counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	147	0	1	01	01	H0543_147_0	2		1	05/30/2014	2015.02	05/30/2014 04:15:39 PM Central Daylight Time	08/04/2014 02:44:33 PM Central Daylight Time	07/31/2014 03:23:34 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	147	0	2015	Stanislaus county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	148	0	1	01	01	H0543_148_0	2		1	05/30/2014	2015.02	05/30/2014 04:16:00 PM Central Daylight Time	08/04/2014 02:45:01 PM Central Daylight Time	07/31/2014 03:23:42 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H0543	148	0	2015	Sonoma county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	151	0	1	01	01	H0543_151_0	2		1	05/30/2014	2015.02	05/30/2014 04:16:16 PM Central Daylight Time	08/04/2014 02:45:28 PM Central Daylight Time	07/31/2014 03:23:51 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0543	151	0	2015	Los Angeles county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	152	0	1	01	01	H0543_152_0	2		1	05/30/2014	2015.02	05/30/2014 04:16:32 PM Central Daylight Time	08/04/2014 02:45:56 PM Central Daylight Time	07/31/2014 03:23:59 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 4 (HMO)	01	01		1			H0543	152	0	2015	San Diego county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	153	0	1	01	01	H0543_153_0	4		1	07/18/2014	2015.02	07/18/2014 09:16:03 AM Central Daylight Time	08/11/2014 02:35:20 PM Central Daylight Time	07/31/2014 03:24:07 PM Central Daylight Time			08/12/2014 02:05:27 PM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 3 (HMO)	01	01		1			H0543	153	0	2015	Los Angeles, Orange, Riverside, and San Bernardino		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0543	802	0	1	01	01	H0543_802_0	1		1	05/22/2014	2015.01	05/22/2014 09:02:57 AM Central Daylight Time	05/30/2014 05:17:26 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	802	0	2015	CA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H0543	805	0	1	01	01	H0543_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:03:09 AM Central Daylight Time	05/30/2014 05:17:55 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	805	0	2015	CA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0543	806	0	1	01	01	H0543_806_0	1		1	05/22/2014	2015.01	05/22/2014 09:03:15 AM Central Daylight Time	05/30/2014 05:18:25 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	UHC OF CALIFORNIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0543	806	0	2015	CA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0544	002	0	1	01	01	H0544_002_0	11		1	08/13/2014	2015.01	08/13/2014 10:46:17 AM Pacific Daylight Time	08/04/2014 11:44:37 AM Pacific Daylight Time	08/01/2014 02:37:59 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	002	0	2015	Los Angeles and Orange Counties (partial)		2	20719	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	003	0	1	01	01	H0544_003_0	8	2	1	08/04/2014	2015.01	08/04/2014 11:42:26 AM Pacific Daylight Time	08/04/2014 11:45:07 AM Pacific Daylight Time	08/01/2014 02:38:11 PM Pacific Daylight Time			08/05/2014 10:10:27 AM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Connect (HMO SNP)	01	01		1			H0544	003	0	2015	Los Angeles County (partial)		2	873	2			1	3		1	4			www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	004	0	1	01	01	H0544_004_0	9		1	08/13/2014	2015.01	08/13/2014 10:46:46 AM Pacific Daylight Time	08/04/2014 11:45:37 AM Pacific Daylight Time	08/01/2014 02:38:23 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Reliance (HMO SNP)	01	01		1			H0544	004	0	2015	Los Angeles and Orange Counties (partial)		2	8472	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	005	0	1	01	01	H0544_005_0	9		1	08/13/2014	2015.01	08/13/2014 10:47:07 AM Pacific Daylight Time	08/04/2014 11:45:22 AM Pacific Daylight Time	08/01/2014 02:38:34 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Touch (HMO SNP)	01	01		1			H0544	005	0	2015	Los Angeles and Orange Counties (partial)		2	1950	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	007	0	1	01	01	H0544_007_0	12		1	08/13/2014	2015.01	08/13/2014 10:47:28 AM Pacific Daylight Time	08/04/2014 11:44:53 AM Pacific Daylight Time	08/01/2014 02:38:46 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H0544	007	0	2015	L.A., Orange, San Bernardino Counties (partial)		2	1006	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	008	0	1	01	01	H0544_008_0	12		1	08/13/2014	2015.01	08/13/2014 10:48:02 AM Pacific Daylight Time	08/04/2014 11:47:23 AM Pacific Daylight Time	08/01/2014 02:38:58 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	008	0	2015	San Bernardino County (partial)		2	1907	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	010	0	1	01	01	H0544_010_0	13		1	08/13/2014	2015.01	08/13/2014 10:48:30 AM Pacific Daylight Time	08/04/2014 11:47:39 AM Pacific Daylight Time	08/01/2014 02:39:10 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Reliance (HMO SNP)	01	01		1			H0544	010	0	2015	San Bernardino County (partial)		2	1452	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(800)589-3145		(800)589-3145		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	012	0	1	01	01	H0544_012_0	12		1	08/13/2014	2015.01	08/13/2014 10:49:08 AM Pacific Daylight Time	08/04/2014 11:48:33 AM Pacific Daylight Time	08/01/2014 02:39:23 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	012	0	2015	Santa Clara County (partial)		2	1911	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	013	0	1	01	01	H0544_013_0	13		1	08/13/2014	2015.01	08/13/2014 10:49:57 AM Pacific Daylight Time	08/04/2014 11:46:07 AM Pacific Daylight Time	08/01/2014 02:39:35 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	013	0	2015	Los Angeles and Orange Counties (partial)		2	1573	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	014	0	1	01	01	H0544_014_0	9		1	08/13/2014	2015.01	08/13/2014 10:50:23 AM Pacific Daylight Time	08/04/2014 11:45:52 AM Pacific Daylight Time	08/01/2014 02:39:47 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	014	0	2015	Los Angeles and Orange Counties (partial)		2	1299	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	015	0	1	01	01	H0544_015_0	7		1	08/13/2014	2015.01	08/13/2014 10:50:46 AM Pacific Daylight Time		08/01/2014 02:39:59 PM Pacific Daylight Time		08/04/2014 12:10:32 PM Pacific Daylight Time	08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore ESRD (HMO SNP)	01	01		1			H0544	015	0	2015	Los Angeles and Orange Counties (partial)		2	1149	2			1	4		1		00000000100000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	019	0	1	01	01	H0544_019_0	8		1	08/13/2014	2015.01	08/13/2014 11:52:14 AM Pacific Daylight Time	08/04/2014 11:47:57 AM Pacific Daylight Time	08/01/2014 02:40:12 PM Pacific Daylight Time			08/13/2014 05:54:16 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	019	0	2015	San Bernardino County (partial)		2	439	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	020	0	1	01	01	H0544_020_0	7		1	08/13/2014	2015.01	08/13/2014 11:41:57 AM Pacific Daylight Time		08/01/2014 02:40:24 PM Pacific Daylight Time		08/04/2014 12:11:20 PM Pacific Daylight Time	08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore ESRD (HMO SNP)	01	01		1			H0544	020	0	2015	San Bernardino County (partial)		2	158	2			1	4		1		00000000100000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(888)357-4177		(888)357-4177		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	021	0	1	01	01	H0544_021_0	10		1	08/13/2014	2015.01	08/13/2014 11:42:15 AM Pacific Daylight Time	08/04/2014 11:48:50 AM Pacific Daylight Time	08/01/2014 02:40:37 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H0544	021	0	2015	Santa Clara County (partial) and Stanislaus County		2	682	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	024	0	1	01	01	H0544_024_0	8		1	08/13/2014	2015.01	08/13/2014 11:42:35 AM Pacific Daylight Time	08/04/2014 11:49:39 AM Pacific Daylight Time	08/01/2014 02:40:48 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	024	0	2015	Santa Clara County (partial)		2	148	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	025	0	1	01	01	H0544_025_0	8		1	08/13/2014	2015.01	08/13/2014 11:43:02 AM Pacific Daylight Time	08/04/2014 11:49:23 AM Pacific Daylight Time	08/01/2014 02:41:00 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H0544	025	0	2015	Santa Clara County (partial)		2	712	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	027	0	1	01	01	H0544_027_0	8		1	08/13/2014	2015.01	08/13/2014 11:49:43 AM Pacific Daylight Time	08/04/2014 11:53:02 AM Pacific Daylight Time	08/01/2014 02:41:13 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H0544	027	0	2015	Stanislaus County		2	1534	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	031	0	1	01	01	H0544_031_0	8		1	08/13/2014	2015.01	08/13/2014 11:49:58 AM Pacific Daylight Time	08/04/2014 11:53:34 AM Pacific Daylight Time	08/01/2014 02:41:25 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H0544	031	0	2015	Stanislaus County		2	142	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	032	0	1	01	01	H0544_032_0	9		1	08/13/2014	2015.01	08/13/2014 11:50:21 AM Pacific Daylight Time	08/04/2014 11:53:19 AM Pacific Daylight Time	08/01/2014 02:41:36 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H0544	032	0	2015	Stanislaus County		2	739	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	036	0	1	01	01	H0544_036_0	9		1	08/13/2014	2015.01	08/13/2014 11:50:41 AM Pacific Daylight Time	08/04/2014 11:53:51 AM Pacific Daylight Time	08/01/2014 02:41:47 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	036	0	2015	Stanislaus County		2	100	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	037	0	1	01	01	H0544_037_0	9		1	08/13/2014	2015.01	08/13/2014 11:51:00 AM Pacific Daylight Time	08/04/2014 11:49:56 AM Pacific Daylight Time	08/01/2014 02:42:01 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	037	0	2015	Santa Clara County (partial)		2	138	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	038	0	1	01	01	H0544_038_0	9		1	08/13/2014	2015.01	08/13/2014 11:51:25 AM Pacific Daylight Time	08/04/2014 11:48:15 AM Pacific Daylight Time	08/01/2014 02:42:13 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H0544	038	0	2015	San Bernardino County (partial)		2	257	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	041	0	1	01	01	H0544_041_0	10	2	1	08/04/2014	2015.01	08/04/2014 12:12:46 PM Pacific Daylight Time	08/04/2014 11:49:07 AM Pacific Daylight Time	08/06/2014 02:06:48 PM Pacific Daylight Time			08/06/2014 03:13:50 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Connect (HMO SNP)	01	01		1			H0544	041	0	2015	Santa Clara County (partial)		2	223	2			1	3		1	4			www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(800)589-3146		(800)589-3146		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	049	0	1	01	01	H0544_049_0	10		1	08/13/2014	2015.01	08/13/2014 10:38:41 AM Pacific Daylight Time	08/04/2014 11:54:08 AM Pacific Daylight Time	08/01/2014 02:42:39 PM Pacific Daylight Time			08/13/2014 06:13:17 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	www.caremore.com	CareMore Flex (HMO)	01	01		1			H0544	049	0	2015	Stanislaus County		2	1800	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(888)426-5985		(888)426-5985		(866)622-2820		(866)622-2820		(888)426-5985		(888)426-5985		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0544	801	0	1	01	01	H0544_801_0	3		1	05/19/2014	2015.01	05/19/2014 11:58:05 AM Pacific Daylight Time	06/10/2014 11:36:12 AM Pacific Daylight Time				06/10/2014 03:31:41 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore EGWP (HMO)	01	01		1			H0544	801	0	2015	California		1	48	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H0544	802	0	1	01	01	H0544_802_0	3		1	05/19/2014	2015.01	05/19/2014 11:57:34 AM Pacific Daylight Time	06/10/2014 11:35:43 AM Pacific Daylight Time				06/10/2014 03:51:40 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H0544	802	0	2015	California		1	48	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H0544	804	0	1	01	01	H0544_804_0	3		1	05/19/2014	2015.01	05/19/2014 11:57:41 AM Pacific Daylight Time	06/10/2014 11:36:41 AM Pacific Daylight Time				06/10/2014 03:51:40 PM Pacific Daylight Time	CAREMORE HEALTH PLAN	CareMore Health Plan	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H0544	804	0	2015	California		1	12	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(855)295-7811		(855)295-7811		(866)622-2820		(866)622-2820		(855)295-7811		(855)295-7811		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H0545	001	0	1	01	01	H0545_001_0	7		1	08/04/2014	2015.01	08/04/2014 02:06:15 PM Pacific Daylight Time	08/04/2014 12:03:40 PM Pacific Daylight Time	08/04/2014 02:06:04 PM Pacific Daylight Time			08/05/2014 02:16:15 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Service To Seniors (HMO)	01	01		1			H0545	001	0	2015	Los Angeles, San Bernardino and Riverside Counties		2	16000	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		2					2					2
H0545	012	0	1	01	01	H0545_012_0	10		1	08/04/2014	2015.01	08/04/2014 02:09:54 PM Pacific Daylight Time	08/05/2014 07:04:32 AM Pacific Daylight Time	08/05/2014 06:39:42 AM Pacific Daylight Time			08/05/2014 02:16:15 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Desert Preferred Choice (HMO)	01	01		1			H0545	012	0	2015	Riverside County		2	6200	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(800)251-8191		(866)756-4407		(866)756-4407		(800)523-3142		(800)523-3142		(866)756-4407		(866)756-4407		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		2					2					2
H0545	013	0	1	01	01	H0545_013_0	7		1	08/04/2014	2015.01	08/04/2014 02:06:54 PM Pacific Daylight Time	08/04/2014 12:06:50 PM Pacific Daylight Time	08/04/2014 10:29:18 AM Pacific Daylight Time			08/05/2014 02:16:15 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan OC Preferred (HMO)	01	01		1			H0545	013	0	2015	Orange County		2	500	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		2					2					2
H0545	801	0	1	01	01	H0545_801_0	2		1	05/09/2014	2015.01	05/09/2014 12:55:48 PM Pacific Daylight Time	07/24/2014 05:32:16 PM Pacific Daylight Time				07/25/2014 05:11:44 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus I (HMO)	01	01		1			H0545	801	0	2015	Counties: LA, OC, RV SB		1	500	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	2					1
H0545	802	0	1	01	01	H0545_802_0	2		1	05/09/2014	2015.01	05/09/2014 12:55:38 PM Pacific Daylight Time	07/24/2014 05:32:38 PM Pacific Daylight Time				07/25/2014 05:11:44 PM Pacific Daylight Time	INTER VALLEY HEALTH PLAN, INC.	Inter Valley Health Plan	www.ivhp.com	Inter Valley Health Plan Active Plus II (HMO)	01	01		1			H0545	802	0	2015	Counties: LA, OC, RV SB		1	500	2			2							http://www.ivhp.com	www.ivhp.com	http://www.ivhp.com	(800)251-8191		(909)623-6333		(800)500-7018		(800)500-7018		(800)523-3142		(800)523-3142		(800)500-7018		(800)500-7018		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		(800)505-7150		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	2					1
H0562	009	0	1	01	01	H0562_009_0	3		1	07/14/2014	2015.01	07/14/2014 04:03:07 PM Pacific Daylight Time	08/05/2014 11:31:39 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	009	0	2015	San Francisco County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	012	0	1	01	01	H0562_012_0	3		1	08/04/2014	2015.01	08/04/2014 11:41:51 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	012	0	2015	San Diego County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	039	0	1	01	01	H0562_039_0	3		1	07/14/2014	2015.01	07/14/2014 04:15:32 PM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	039	0	2015	Yolo county		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	040	0	1	01	01	H0562_040_0	3		1	07/14/2014	2015.01	07/14/2014 06:36:23 PM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	040	0	2015	San Diego County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	044	0	1	01	01	H0562_044_0	2		1	07/14/2014	2015.01	07/14/2014 04:18:30 PM Pacific Daylight Time	05/31/2014 03:28:33 PM Pacific Daylight Time				07/15/2014 03:26:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Green (HMO)	01	01		1			H0562	044	0	2015	L.A., Riverside, S.Bern. Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										2					2					2
H0562	045	0	1	01	01	H0562_045_0	2		1	07/14/2014	2015.01	07/14/2014 04:20:41 PM Pacific Daylight Time	05/31/2014 03:28:33 PM Pacific Daylight Time				07/15/2014 03:26:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Green (HMO)	01	01		1			H0562	045	0	2015	No. CA Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										2					2					2
H0562	055	0	1	01	01	H0562_055_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:43:04 PM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Amber I (HMO SNP)	01	01		1			H0562	055	0	2015	L.A., Kern, Orange, Riverside and San Bernardino		2		2			1	3		1	2			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	068	0	1	01	01	H0562_068_0	3		1	07/14/2014	2015.01	07/14/2014 04:23:13 PM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	068	0	2015	Alameda and Stanislaus Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	070	0	1	01	01	H0562_070_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:43:41 PM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time	08/05/2014 11:31:45 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Amber II (HMO SNP)	01	01		1			H0562	070	0	2015	Parts of So. Ca., Fresno, S.F., Sac., Stan.,Tulare		2		2			1	3		1	2			www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	079	0	1	01	01	H0562_079_0	3		1	08/04/2014	2015.01	08/04/2014 11:43:34 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	079	0	2015	Kern County, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	084	0	1	01	01	H0562_084_0	3		1	07/14/2014	2015.01	07/14/2014 06:39:12 PM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	084	0	2015	Placer, Sacramento Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	089	0	1	01	01	H0562_089_0	3		1	07/14/2014	2015.01	07/14/2014 02:43:08 PM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	089	0	2015	Santa Clara County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	090	0	1	01	01	H0562_090_0	3		1	08/04/2014	2015.01	08/04/2014 11:01:23 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	090	0	2015	Fresno County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	092	0	1	01	01	H0562_092_0	3		1	08/04/2014	2015.01	08/04/2014 11:01:40 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H0562	092	0	2015	Kern, L. A. and Orange Counties		2		2			1	4		1		00000000000000000010		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	093	0	1	01	01	H0562_093_0	3		1	07/14/2014	2015.01	07/14/2014 02:49:37 PM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	093	0	2015	Santa Cruz County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	095	0	1	01	01	H0562_095_0	3		1	07/14/2014	2015.01	07/14/2014 02:49:59 PM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time	08/05/2014 11:31:46 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	095	0	2015	Santa Clara County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	096	0	1	01	01	H0562_096_0	3		1	07/14/2014	2015.01	07/14/2014 05:43:35 PM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	096	0	2015	Sonoma County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	097	0	1	01	01	H0562_097_0	2		1	08/05/2014	2015.01	08/05/2014 09:03:45 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	097	0	2015	San Francisco, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	100	1	1	01	01	H0562_100_1	3		1	08/04/2014	2015.01	08/04/2014 11:45:12 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	100	1	2015	LA, Orange, Riverside and San Bernardino Counties	Los Angeles and Orange Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	100	2	1	01	01	H0562_100_2	3		1	08/04/2014	2015.01	08/04/2014 11:45:59 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Healthy Heart (HMO)	01	01		1			H0562	100	2	2015	LA, Orange, Riverside and San Bernardino Counties	Riverside and San Bernardino Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	101	1	1	01	01	H0562_101_1	3		1	08/04/2014	2015.01	08/04/2014 11:47:11 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Gold Select (HMO)	01	01		1			H0562	101	1	2015	LA, Orange, Riverside and San Bernardino Counties	Los Angeles and Orange Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	101	2	1	01	01	H0562_101_2	3		1	08/04/2014	2015.01	08/04/2014 11:48:05 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time	08/05/2014 11:31:47 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Gold Select (HMO)	01	01		1			H0562	101	2	2015	LA, Orange, Riverside and San Bernardino Counties	Riverside and San Bernardino Counties	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	102	0	1	01	01	H0562_102_0	3		1	08/04/2014	2015.01	08/04/2014 11:09:10 AM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	102	0	2015	Placer and Sacramento Counties, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	103	0	1	01	01	H0562_103_0	3		1	08/04/2014	2015.01	08/04/2014 11:10:35 AM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Ruby Select (HMO)	01	01		1			H0562	103	0	2015	Yolo County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H0562	104	0	1	01	01	H0562_104_0	3		1	08/05/2014	2015.01	08/05/2014 03:44:11 PM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Sapphire (HMO)	01	01		1			H0562	104	0	2015	Kern L.A., Org, Riv., S.Bern., S.D. Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(800)431-9007		(800)431-9007		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	105	0	1	01	01	H0562_105_0	3		1	07/24/2014	2015.01	07/24/2014 05:55:23 PM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time	08/05/2014 11:31:48 AM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Ruby (HMO)	01	01		1			H0562	105	0	2015	Santa Barbara		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	106	0	1	01	01	H0562_106_0	3		1	08/05/2014	2015.01	08/05/2014 11:25:34 AM Pacific Daylight Time	08/06/2014 12:28:56 PM Pacific Daylight Time	08/06/2014 12:28:57 PM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Complete (HMO)	01	01		1			H0562	106	0	2015	Kern, L.A., Orange, Riverside, SB, SD, Sta Barbara		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	108	0	1	01	01	H0562_108_0	3		1	08/05/2014	2015.01	08/05/2014 11:30:04 AM Pacific Daylight Time	08/06/2014 12:28:58 PM Pacific Daylight Time	08/06/2014 12:28:58 PM Pacific Daylight Time			08/06/2014 12:36:51 PM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Complete (HMO)	01	01		1			H0562	108	0	2015	No. Calif. Counties		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0562	801	0	1	01	01	H0562_801_0	3		1	06/04/2014	2015.01	06/04/2014 10:15:08 AM Pacific Daylight Time	05/31/2014 03:28:34 PM Pacific Daylight Time				06/04/2014 10:44:03 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	801	0	2015	California		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0562	803	0	1	01	01	H0562_803_0	3		1	06/04/2014	2015.01	06/04/2014 10:15:18 AM Pacific Daylight Time	05/31/2014 03:28:34 PM Pacific Daylight Time				06/04/2014 10:44:03 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	803	0	2015	California		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0562	804	0	1	01	01	H0562_804_0	3		1	06/04/2014	2015.01	06/04/2014 10:15:28 AM Pacific Daylight Time	05/31/2014 03:28:34 PM Pacific Daylight Time				06/04/2014 10:44:03 AM Pacific Daylight Time	HEALTH NET OF CALIFORNIA,INC.	Health Net of California	www.healthnet.com/medicare	Health Net Seniority Plus Employer (HMO)	01	01		1			H0562	804	0	2015	California		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)275-4737		(800)275-4737		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H0564	055	0	1	01	01	H0564_055_0	7	2	1	08/06/2014	2015.01	08/06/2014 09:02:37 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H0564	055	0	2015	Fresno County		2	350	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	056	0	1	01	01	H0564_056_0	8	2	1	06/01/2014	2015.01	06/01/2014 12:29:50 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H0564	056	0	2015	Kern County		2	400	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	058	0	1	01	01	H0564_058_0	8	2	1	06/01/2014	2015.01	06/01/2014 12:29:58 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H0564	058	0	2015	San Francisco County		2	500	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	059	0	1	01	01	H0564_059_0	8	2	1	06/01/2014	2015.01	06/01/2014 12:30:04 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H0564	059	0	2015	Ventura County		2	400	2			1	3		1	5				www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	060	0	1	01	01	H0564_060_0	12		1	08/06/2014	2015.01	08/06/2014 09:11:20 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan I (HMO)	01	01		1			H0564	060	0	2015	Fresno County		2	400	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	061	0	1	01	01	H0564_061_0	13		1	08/06/2014	2015.01	08/06/2014 10:54:43 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan I (HMO)	01	01		1			H0564	061	0	2015	San Francisco County		2	400	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	062	0	1	01	01	H0564_062_0	14		1	08/06/2014	2015.01	08/06/2014 09:37:05 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem Select Advantage (HMO)	01	01		1			H0564	062	0	2015	Los Angeles County		2	2318	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	063	0	1	01	01	H0564_063_0	12		1	08/06/2014	2015.01	08/06/2014 09:39:33 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Anthem Select Advantage (HMO)	01	01		1			H0564	063	0	2015	Orange County		2	1300	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	067	1	1	01	01	H0564_067_1	13		1	08/06/2014	2015.01	08/06/2014 09:47:57 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan I (HMO)	01	01		1			H0564	067	1	2015	San Bernardino and Riverside Counties	San Bernardino County	2	1150	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	067	2	1	01	01	H0564_067_2	14		1	08/06/2014	2015.01	08/06/2014 01:35:20 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan I (HMO)	01	01		1			H0564	067	2	2015	San Bernardino and Riverside Counties	Riverside County	2	1250	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	068	0	1	01	01	H0564_068_0	16		1	08/06/2014	2015.01	08/06/2014 10:09:44 AM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan I (HMO)	01	01		1			H0564	068	0	2015	Orange and Los Angeles Counties		2	2781	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	069	0	1	01	01	H0564_069_0	14		1	08/06/2014	2015.01	08/06/2014 03:24:36 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan II (HMO)	01	01		1			H0564	069	0	2015	Kern County		2	1510	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	070	0	1	01	01	H0564_070_0	13		1	08/06/2014	2015.01	08/06/2014 10:21:14 AM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Blue Cross Senior Secure Plan II (HMO)	01	01		1			H0564	070	0	2015	Ventura County		2	383	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(888)230-7338		(888)230-7338		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0564	801	0	1	01	01	H0564_801_0	8		1	06/03/2014	2015.01	06/03/2014 01:09:57 PM Pacific Daylight Time	07/15/2014 01:19:52 PM Pacific Daylight Time				07/15/2014 03:30:26 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0564	801	0	2015	California, Select Counties		1	1213	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111110011101	1	111111111111111111111100110	1					1
H0564	810	0	1	01	01	H0564_810_0	8		1	05/31/2014	2015.01	05/31/2014 10:44:31 AM Pacific Daylight Time	07/15/2014 01:19:57 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0564	810	0	2015	California, Select Counties		1	50	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111110011101	1	111111111111111111111100110	1					1
H0564	811	0	1	01	01	H0564_811_0	8		1	05/31/2014	2015.01	05/31/2014 10:44:47 AM Pacific Daylight Time	07/15/2014 01:20:03 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	BLUE CROSS OF CALIFORNIA	Anthem Blue Cross	www.anthem.com/ca/medicare	Senior Secure (HMO)	01	01		1			H0564	811	0	2015	California Select Counties		1	50	2			2								www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(800)225-2273		(800)225-2273		(877)826-1831		(877)826-1831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111110011101	1	111111111111111111111100110	1					1
H0571	001	0	1	01	01	H0571_001_0	5		1	07/08/2014	2015.01	07/08/2014 01:17:40 PM Pacific Daylight Time	08/05/2014 09:44:12 AM Pacific Daylight Time	07/31/2014 01:47:14 PM Pacific Daylight Time			08/05/2014 12:20:23 PM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphmo.com/medicare	CCHP Senior Program (HMO)	01	01		1			H0571	001	0	2015	San Francisco and Northern San Mateo counties		2	4236	2			2								www.cchphmo.com/medicare-rx-benefit-information-including-part-d	www.cchphmo.com/medicare-rx-benefit-information-including-part-d	(888)775-7888		(415)834-2118		(888)371-3060		(415)955-8800	3282	(888)775-7888		(415)834-2118		(888)371-3060		(415)955-8800	3282	(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		2					2					2
H0571	005	0	1	01	01	H0571_005_0	4	2	1	07/08/2014	2015.01	07/08/2014 01:18:04 PM Pacific Daylight Time	08/05/2014 09:46:13 AM Pacific Daylight Time	07/31/2014 01:48:12 PM Pacific Daylight Time			08/05/2014 12:20:23 PM Pacific Daylight Time	CHINESE COMMUNITY HEALTH PLAN	Chinese Community Health Plan	www.cchphmo.com/medicare	CCHP Senior Select Program (HMO SNP)	01	01		1			H0571	005	0	2015	San Francisco County		2	4632	2			1	3		1	2				www.cchphmo.com/medicare-rx-benefit-information-including-part-d	www.cchphmo.com/medicare-rx-benefit-information-including-part-d	(888)775-7888		(415)834-2118		(888)371-3060		(415)955-8800	3282	(888)775-7888		(415)834-2118		(888)371-3060		(415)955-8800	3282	(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		(877)681-8898		2					2					2
H0602	001	0	1	18	06	H0602_001_0	5		1	07/24/2014	2015.01	07/24/2014 02:10:32 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	001	0	2015	Western Slope Colorado		2	1200	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	003	0	1	18	06	H0602_003_0	5		1	07/24/2014	2015.01	07/24/2014 02:11:56 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Plus Plan (Cost)	06	18		1			H0602	003	0	2015	Colorado		2	50	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	007	0	1	18	06	H0602_007_0	5		1	07/24/2014	2015.01	07/24/2014 02:12:51 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	007	0	2015	Front Range Colorado		2	400	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	009	0	1	18	06	H0602_009_0	5		1	07/24/2014	2015.01	07/24/2014 02:13:33 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan (Cost)	06	18		1			H0602	009	0	2015	Denver Metro/Boulder Colorado		2	300	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	017	0	1	18	06	H0602_017_0	6		1	07/24/2014	2015.01	07/24/2014 02:14:11 PM Mountain Daylight Time		05/31/2014 11:33:44 AM Mountain Daylight Time			07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan + Rx (Cost)	06	18		1			H0602	017	0	2015	Western Slope Colorado		2	5500	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0602	019	0	1	18	06	H0602_019_0	4		1	07/24/2014	2015.01	07/24/2014 02:14:52 PM Mountain Daylight Time		05/31/2014 11:33:45 AM Mountain Daylight Time			07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Plus Plan + Rx (Cost)	06	18		1			H0602	019	0	2015	Colorado		2	1000	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0602	020	0	1	18	06	H0602_020_0	6		1	07/24/2014	2015.01	07/24/2014 02:15:47 PM Mountain Daylight Time		05/31/2014 11:33:45 AM Mountain Daylight Time			07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan + Rx (Cost)	06	18		1			H0602	020	0	2015	Front Range Colorado		2	1600	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0602	022	0	1	18	06	H0602_022_0	4		1	07/24/2014	2015.01	07/24/2014 02:16:20 PM Mountain Daylight Time		05/31/2014 11:33:46 AM Mountain Daylight Time			07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Standard Plan + Rx (Cost)	06	18		1			H0602	022	0	2015	Denver Metro/Boulder Colorado		2	1600	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0602	026	0	1	18	06	H0602_026_0	4		1	05/30/2014	2015.01	05/30/2014 02:40:45 PM Mountain Daylight Time					05/31/2014 11:40:32 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	AB Basic Plan (Cost)	06	18		1			H0602	026	0	2015	Colorado		2	1000	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										1	1	000000010001100101110111011100000110	2		2					2
H0602	027	0	1	18	06	H0602_027_0	5		1	07/24/2014	2015.01	07/24/2014 02:18:22 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Thrifty Plan (Cost)	06	18		1			H0602	027	0	2015	Colorado		2	800	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	039	0	1	18	06	H0602_039_0	6		1	07/24/2014	2015.01	07/24/2014 02:19:04 PM Mountain Daylight Time		05/31/2014 11:33:46 AM Mountain Daylight Time			07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Thrifty Plan + Rx (Cost)	06	18		1			H0602	039	0	2015	Colorado		2	1400	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0602	040	0	2	18	06	H0602_040_0	4		1	05/30/2014	2015.01	05/30/2014 11:14:12 AM Mountain Daylight Time					05/31/2014 11:40:32 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	B Basic Plan (Cost)	06	18		2	2		H0602	040	0	2015	Colorado		2	10	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										1	1	000000010001100101110111011100000110	2		2					2
H0602	041	0	2	18	06	H0602_041_0	4		1	07/24/2014	2015.01	07/24/2014 02:21:17 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	B Standard Plan (Cost)	06	18		2	2		H0602	041	0	2015	Colorado		2	15	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	042	0	1	18	06	H0602_042_0	5		1	07/24/2014	2015.01	07/24/2014 02:22:25 PM Mountain Daylight Time					07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Green Plan (Cost)	06	18		1			H0602	042	0	2015	Colorado		2	1800	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912										(711)-		(711)-		(711)-		(711)-										2					2					2
H0602	043	0	1	18	06	H0602_043_0	6		1	07/24/2014	2015.01	07/24/2014 02:23:01 PM Mountain Daylight Time		05/31/2014 11:33:43 AM Mountain Daylight Time			07/24/2014 03:05:17 PM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Rocky Mountain Green Plan + Rx (Cost)	06	18		1			H0602	043	0	2015	Colorado		2	3200	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0602	801	0	1	18	06	H0602_801_0	3		1	05/23/2014	2015.01	05/23/2014 09:17:18 AM Mountain Daylight Time					05/31/2014 11:40:32 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION	Rocky Mountain Health Plans	www.rmhpmedicare.org	Group Plus Plan (Cost)	06	18		1			H0602	801	0	2015	Colorado		1	4400	2			2								www.rmhpmedicare.org	www.rmhpmedicare.org	(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(888)282-1420		(970)244-7912		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H0609	002	0	1	01	01	H0609_002_0	4		1	05/30/2014	2015.02	05/30/2014 04:27:33 PM Central Daylight Time	08/04/2014 05:14:20 PM Central Daylight Time	07/31/2014 03:24:15 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0609	002	0	2015	El Paso, Fremont, Larimer, Pueblo, Teller, Weld		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0609	007	0	1	01	01	H0609_007_0	4		1	05/30/2014	2015.02	05/30/2014 04:27:42 PM Central Daylight Time	08/04/2014 04:55:11 PM Central Daylight Time	07/31/2014 03:24:23 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H0609	007	0	2015	Denver Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0609	012	0	1	01	01	H0609_012_0	4		1	05/30/2014	2015.02	05/30/2014 04:27:53 PM Central Daylight Time	08/04/2014 04:53:12 PM Central Daylight Time	07/31/2014 03:24:32 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0609	012	0	2015	Denver Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0609	015	0	1	01	01	H0609_015_0	2		1	05/27/2014	2015.02	05/27/2014 07:28:29 PM Central Daylight Time	05/30/2014 05:20:42 PM Central Daylight Time				05/31/2014 10:35:47 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0609	015	0	2015	El Paso, Fremont, Larimer, Pueblo, Teller, Weld		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H0609	018	0	1	01	01	H0609_018_0	2		1	05/21/2014	2015.02	05/21/2014 11:19:21 AM Central Daylight Time	05/30/2014 05:21:11 PM Central Daylight Time				05/31/2014 10:35:47 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H0609	018	0	2015	Denver Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H0609	020	0	1	01	01	H0609_020_0	4		1	05/30/2014	2015.02	05/30/2014 04:28:03 PM Central Daylight Time	08/04/2014 04:54:17 PM Central Daylight Time	07/31/2014 03:24:40 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H0609	020	0	2015	El Paso, Fremont, Larimer, Pueblo, Teller, Weld		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0609	801	0	1	01	01	H0609_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:03:29 AM Central Daylight Time	05/30/2014 05:22:08 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	801	0	2015	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H0609	804	0	1	01	01	H0609_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:03:39 AM Central Daylight Time	05/30/2014 05:22:38 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	804	0	2015	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0609	805	0	1	01	01	H0609_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:03:48 AM Central Daylight Time	05/30/2014 05:23:06 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0609	805	0	2015	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0609	806	0	2	01	01	H0609_806_0	1		1	05/22/2014	2015.01	05/22/2014 09:03:59 AM Central Daylight Time	05/30/2014 05:23:36 PM Central Daylight Time				05/31/2014 10:22:24 AM Central Daylight Time	PACIFICARE OF COLORADO, INC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H0609	806	0	2015	CO Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H0613	001	0	1	20	08	H0613_001_0	1		1	05/28/2014	2015.01	05/28/2014 10:11:34 AM Mountain Daylight Time		05/17/2014 09:12:21 AM Mountain Daylight Time			05/28/2014 10:35:59 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	Total Longterm Care, Inc.	totallongtermcare.org	Total Longterm Care - Dual eligibles (PACE)	08	20		1			H0613	001	0	2015	Metropolitan Denver		2		2			2								http://www.totallongtermcare.org	http://www.pharmerica.com									(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664										(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664												
H0613	003	0	1	20	08	H0613_003_0	1		1	05/28/2014	2015.01	05/28/2014 10:15:02 AM Mountain Daylight Time		05/17/2014 09:19:31 AM Mountain Daylight Time			05/28/2014 10:35:59 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	Total Longterm Care, Inc.	totallongtermcare.org	Total Longterm Care - Medicare only (PACE)	08	20		1			H0613	003	0	2015	Metropolitian Denver		2		2			2								http://www.totallongtermcare.org	http://www.pharmerica.com									(303)869-4664		(303)869-4664		(877)277-6163		(303)869-4664										(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664												
H0620	002	0	1	04	01	H0620_002_0	4		1	07/18/2014	2015.02	07/18/2014 09:23:33 AM Central Daylight Time	08/04/2014 04:01:56 PM Central Daylight Time	07/31/2014 03:24:49 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0620	002	0	2015	Northern and Central Colorado		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0621	006	0	1	01	01	H0621_006_0	9		1	08/06/2014	2015.01	08/06/2014 09:14:32 AM Mountain Daylight Time	08/01/2014 02:40:31 PM Mountain Daylight Time	08/01/2014 02:38:55 PM Mountain Daylight Time			08/06/2014 10:37:34 AM Mountain Daylight Time	COLORADO ACCESS	Colorado Access Advantage	www.coaccess.com	Colorado Access Advantage Peak Plan (HMO)	01	01		1			H0621	006	0	2015	Denver Metro, El Paso, San Luis Valley, Northeast		2	1126	1	1		2							http://www.aa.coaccess.com	http://www.aa.coaccess.com	http://www.aa.coaccess.com	(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		2					2					2
H0621	010	0	1	01	01	H0621_010_0	7	2	1	08/02/2014	2015.01	08/02/2014 09:24:53 PM Mountain Daylight Time	07/31/2014 05:15:58 PM Mountain Daylight Time	07/31/2014 05:12:40 PM Mountain Daylight Time			08/06/2014 10:37:34 AM Mountain Daylight Time	COLORADO ACCESS	Colorado Access Advantage	www.coaccess.com	Colorado Access Advantage Summit Plan (HMO SNP)	01	01		1			H0621	010	0	2015	Denver Metro, El Paso, San Luis Valley, Northeast		2	2897	1	1		1	3		1	4			http://www.aa.coaccess.com	http://www.aa.coaccess.com	http://www.aa.coaccess.com	(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494		2					2					2
H0624	001	0	1	01	01	H0624_001_0	2	2	1	05/30/2014	2015.02	05/30/2014 10:57:09 AM Central Daylight Time	08/04/2014 03:58:01 PM Central Daylight Time	07/31/2014 03:24:57 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H0624	001	0	2015	Denver and Colorado Springs metro areas		2		2			1	3		1	2			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	013	0	1	01	01	H0630_013_0	8		1	08/04/2014	2015.01	08/04/2014 02:58:22 PM Mountain Daylight Time	08/04/2014 03:37:16 PM Mountain Daylight Time	08/04/2014 03:49:33 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	013	0	2015	Denver Metro Area		2	20475	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	014	0	1	01	01	H0630_014_0	9	2	1	07/23/2014	2015.01	07/23/2014 12:38:47 PM Mountain Daylight Time	08/04/2014 03:37:36 PM Mountain Daylight Time	08/04/2014 03:50:24 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Medicare Medicaid Plan (HMO SNP)	01	01		1			H0630	014	0	2015	Denver Metro Area		2	2369	2			1	3		1	2			kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	015	0	1	01	01	H0630_015_0	11		1	07/23/2014	2015.01	07/23/2014 12:38:32 PM Mountain Daylight Time	08/04/2014 03:37:58 PM Mountain Daylight Time	08/04/2014 03:51:10 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	015	0	2015	Denver Metro Area		2	31280	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	016	0	1	01	01	H0630_016_0	8		1	07/23/2014	2015.01	07/23/2014 12:40:58 PM Mountain Daylight Time	08/04/2014 03:38:19 PM Mountain Daylight Time	08/04/2014 03:51:58 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Gold (HMO)	01	01		1			H0630	016	0	2015	Denver Metro Area		2	3384	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	017	0	1	01	01	H0630_017_0	8		1	08/04/2014	2015.01	08/04/2014 03:16:03 PM Mountain Daylight Time	08/04/2014 03:38:41 PM Mountain Daylight Time	08/04/2014 03:52:42 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Core (HMO)	01	01		1			H0630	017	0	2015	Southern Colorado		2	4856	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	018	0	1	01	01	H0630_018_0	8		1	07/23/2014	2015.01	07/23/2014 12:41:55 PM Mountain Daylight Time	08/04/2014 03:39:02 PM Mountain Daylight Time	08/04/2014 03:53:25 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Silver (HMO)	01	01		1			H0630	018	0	2015	Southern Colorado		2	1941	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	020	0	1	01	01	H0630_020_0	8		1	08/04/2014	2015.01	08/04/2014 03:52:59 PM Mountain Daylight Time	08/04/2014 03:39:24 PM Mountain Daylight Time	08/04/2014 03:54:10 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Core Plan (HMO)	01	01		1			H0630	020	0	2015	Northern Colorado		2	1830	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	021	0	1	01	01	H0630_021_0	8		1	07/23/2014	2015.01	07/23/2014 12:42:46 PM Mountain Daylight Time	08/04/2014 03:39:45 PM Mountain Daylight Time	08/04/2014 03:54:56 PM Mountain Daylight Time			08/06/2014 10:51:43 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Silver Plan (HMO)	01	01		1			H0630	021	0	2015	Northern Colorado		2	1700	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0630	805	0	2	01	01	H0630_805_0	2		1	05/08/2014	2015.01	05/08/2014 05:53:07 PM Mountain Daylight Time	05/29/2014 09:41:35 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	01	01		2	1		H0630	805	0	2015	Denver Metro Area		1	717	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	806	0	2	01	01	H0630_806_0	2		1	05/08/2014	2015.01	05/08/2014 05:54:46 PM Mountain Daylight Time	05/29/2014 09:41:57 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	01	01		2	1		H0630	806	0	2015	Denver Metro Area		1	0	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	807	0	1	01	01	H0630_807_0	2		1	05/08/2014	2015.01	05/08/2014 05:56:31 PM Mountain Daylight Time	05/29/2014 09:42:18 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA-PD (HMO)	01	01		1			H0630	807	0	2015	Denver Metro Area		1	22703	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	808	0	1	01	01	H0630_808_0	2		1	05/08/2014	2015.01	05/08/2014 05:57:33 PM Mountain Daylight Time	05/29/2014 09:42:39 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Adv_Group_MA only (HMO)	01	01		1			H0630	808	0	2015	Denver Metro Area		1	9	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	809	0	2	01	01	H0630_809_0	2		1	05/08/2014	2015.01	05/08/2014 05:58:30 PM Mountain Daylight Time	05/29/2014 09:43:01 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H0630	809	0	2015	Denver Metro Area		1	9	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	810	0	1	01	01	H0630_810_0	2		1	05/08/2014	2015.01	05/08/2014 05:59:26 PM Mountain Daylight Time	05/29/2014 09:43:22 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	810	0	2015	Denver Metro Area		1	2740	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	811	0	2	01	01	H0630_811_0	2		1	05/08/2014	2015.01	05/08/2014 06:00:47 PM Mountain Daylight Time	05/29/2014 09:43:43 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA-PD_Part B only (HMO)	01	01		2	1		H0630	811	0	2015	Southern Colorado		1	113	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	812	0	2	01	01	H0630_812_0	2		1	05/08/2014	2015.01	05/08/2014 06:01:56 PM Mountain Daylight Time	05/29/2014 09:44:05 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA only_Part B only (HMO)	01	01		2	1		H0630	812	0	2015	Southern Colorado		1	0	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	813	0	1	01	01	H0630_813_0	2		1	05/08/2014	2015.01	05/08/2014 06:03:03 PM Mountain Daylight Time	05/29/2014 09:44:26 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA-PD (HMO)	01	01		1			H0630	813	0	2015	Southern Colorado		1	2539	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	814	0	1	01	01	H0630_814_0	4		1	05/08/2014	2015.01	05/08/2014 06:03:56 PM Mountain Daylight Time	05/29/2014 09:44:48 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Adv Group_MA only (HMO)	01	01		1			H0630	814	0	2015	Southern Colorado		1	0	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	815	0	2	01	01	H0630_815_0	4		1	05/08/2014	2015.01	05/08/2014 06:04:50 PM Mountain Daylight Time	05/29/2014 09:45:09 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H0630	815	0	2015	Southern Colorado		1	0	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	816	0	1	01	01	H0630_816_0	2		1	05/08/2014	2015.01	05/08/2014 06:05:46 PM Mountain Daylight Time	05/29/2014 09:45:30 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	816	0	2015	Southern Colorado		1	226	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	817	0	2	01	01	H0630_817_0	2		1	05/08/2014	2015.01	05/08/2014 06:06:34 PM Mountain Daylight Time	05/29/2014 09:45:51 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MAPD Part B Only (HMO)	01	01		2	1		H0630	817	0	2015	Northern Colorado		1	21	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	818	0	2	01	01	H0630_818_0	2		1	05/08/2014	2015.01	05/08/2014 06:07:23 PM Mountain Daylight Time	05/29/2014 09:46:12 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA Only Part B Only (HMO)	01	01		2	1		H0630	818	0	2015	Northern Colorado		1	0	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	819	0	1	01	01	H0630_819_0	2		1	05/08/2014	2015.01	05/08/2014 06:08:13 PM Mountain Daylight Time	05/29/2014 09:46:34 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MAPD (HMO)	01	01		1			H0630	819	0	2015	Northern Colorado		1	739	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	820	0	1	01	01	H0630_820_0	2		1	05/08/2014	2015.01	05/08/2014 06:08:59 PM Mountain Daylight Time	05/29/2014 09:46:55 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	Senior Advantage Group MA Only (HMO)	01	01		1			H0630	820	0	2015	Northern Colorado		1	1	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	821	0	2	01	01	H0630_821_0	2		1	05/08/2014	2015.01	05/08/2014 06:09:47 PM Mountain Daylight Time	05/29/2014 09:47:16 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	FEHB B Only with D (HMO)	01	01		2	1		H0630	821	0	2015	Northern Colorado		1	0	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0630	822	0	1	01	01	H0630_822_0	2		1	05/08/2014	2015.01	05/08/2014 06:10:40 PM Mountain Daylight Time	05/29/2014 09:47:37 PM Mountain Daylight Time				05/30/2014 09:52:55 AM Mountain Daylight Time	KAISER FOUNDATION HP OF CO	Kaiser Permanente	www.kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H0630	822	0	2015	Northern Colorado		1	81	2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(800)476-2167		(303)338-3800		(877)408-3492		(877)408-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	000000000000000000000001000	1					2
H0657	005	0	1	18	06	H0657_005_0	3		2	07/23/2014	2015.01	07/23/2014 05:43:26 PM Mountain Daylight Time					07/23/2014 05:51:00 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Silver SV Plan (Cost)	06	18		1			H0657	005	0	2015	The 6 County San Luis Valley Area		2	125	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2
H0657	006	0	1	18	06	H0657_006_0	3		2	07/23/2014	2015.01	07/23/2014 05:44:46 PM Mountain Daylight Time					07/23/2014 05:51:00 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Gold SV Plan (Cost)	06	18		1			H0657	006	0	2015	The 6 County San Luis Valley Area		2	50	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2
H0657	007	0	1	18	06	H0657_007_0	3		2	07/23/2014	2015.01	07/23/2014 05:45:32 PM Mountain Daylight Time					07/23/2014 05:51:00 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Platinum SV Plan (Cost)	06	18		1			H0657	007	0	2015	The 6 County San Luis Valley Area		2	520	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2
H0657	008	0	1	18	06	H0657_008_0	3		2	07/23/2014	2015.01	07/23/2014 05:35:37 PM Mountain Daylight Time					07/23/2014 05:51:00 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Silver Plan (Cost)	06	18		1			H0657	008	0	2015	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	110	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2
H0657	009	0	1	18	06	H0657_009_0	3		2	07/23/2014	2015.01	07/23/2014 05:36:43 PM Mountain Daylight Time					07/23/2014 05:51:00 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Gold Plan (Cost)	06	18		1			H0657	009	0	2015	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	10	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2
H0657	010	0	1	18	06	H0657_010_0	3		2	07/23/2014	2015.01	07/23/2014 05:37:59 PM Mountain Daylight Time					07/23/2014 05:51:00 PM Mountain Daylight Time	COLORADO CHOICE HEALTH PLANS	Colorado Choice Health Plans	www.cochoice.com	Colorado Choice Platinum Plan (Cost)	06	18		1			H0657	010	0	2015	BEN, CHA, CRO, CUS, FRE, HUE, LAS, OTE, PRO, YUM		2	15	2			2										(800)475-8466		(719)589-3696		(800)475-8466		(719)589-3696										(800)659-2656		(800)659-2656		(800)659-2656		(800)659-2656										2					2					2
H0710	001	0	1	04	01	H0710_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:23:59 AM Central Daylight Time	08/04/2014 05:49:59 PM Central Daylight Time	07/31/2014 03:25:06 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H0710	001	0	2015	Select Counties in Connecticut		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H0712	005	0	1	01	01	H0712_005_0	7	2	1	08/04/2014	2015.02	08/04/2014 01:17:55 PM Eastern Daylight Time	08/05/2014 11:18:20 AM Eastern Daylight Time	08/01/2014 11:24:48 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H0712	005	0	2015	Fairfield, Hartford, New Haven, Tolland Counties		2	11790	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)635-7047		(866)635-7047		(877)817-5794		(877)817-5794		(866)635-7047		(866)635-7047		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H0712	019	0	1	01	01	H0712_019_0	6		1	08/06/2014	2015.02	08/06/2014 09:42:27 AM Eastern Daylight Time	08/05/2014 11:18:33 AM Eastern Daylight Time	08/01/2014 11:24:58 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com	Wellcare Value (HMO)	01	01		1			H0712	019	0	2015	Fairfield, Hartford, New Haven, Tolland Counties		2	1969	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)579-8006		(866)579-8006		(877)817-5794		(877)817-5794		(866)579-8006		(866)579-8006		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H0712	020	0	1	01	01	H0712_020_0	7		1	08/06/2014	2015.02	08/06/2014 09:42:34 AM Eastern Daylight Time	08/05/2014 05:01:21 PM Eastern Daylight Time	08/01/2014 11:25:09 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE OF CONNECTICUT, INC.	WellCare	www.wellcare.com	WellCare Rx (HMO)	01	01		1			H0712	020	0	2015	Fairfield, Hartford, New Haven, Tolland Counties		2	2039	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)579-8006		(866)579-8006		(877)817-5794		(877)817-5794		(866)579-8006		(866)579-8006		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H0755	030	0	1	01	01	H0755_030_0	2		1	05/30/2014	2015.01	05/30/2014 04:26:20 PM Central Daylight Time	08/04/2014 02:53:47 PM Central Daylight Time	07/31/2014 03:25:15 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 1 (HMO)	01	01		1			H0755	030	0	2015	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0755	031	0	1	01	01	H0755_031_0	2		1	05/30/2014	2015.01	05/30/2014 04:26:51 PM Central Daylight Time	08/04/2014 02:54:15 PM Central Daylight Time	07/31/2014 03:12:13 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 2 (HMO)	01	01		1			H0755	031	0	2015	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0755	032	0	1	01	01	H0755_032_0	1		1	05/30/2014	2015.01	05/30/2014 11:11:03 AM Central Daylight Time	05/30/2014 04:45:47 PM Central Daylight Time				05/31/2014 10:29:26 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Essential (HMO)	01	01		1			H0755	032	0	2015	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					2
H0755	033	0	1	01	01	H0755_033_0	2		1	05/30/2014	2015.01	05/30/2014 04:27:26 PM Central Daylight Time	08/04/2014 02:54:44 PM Central Daylight Time	07/31/2014 03:12:17 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Plan 3 (HMO)	01	01		1			H0755	033	0	2015	Connecticut		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(800)711-0646		(800)711-0646		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0755	810	0	1	01	01	H0755_810_0	1		1	05/22/2014	2015.01	05/22/2014 09:04:30 AM Central Daylight Time	05/30/2014 04:46:25 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	810	0	2015	Connecticut		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H0755	811	0	1	01	01	H0755_811_0	1		1	05/22/2014	2015.01	05/22/2014 09:04:40 AM Central Daylight Time	05/30/2014 04:46:45 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	811	0	2015	Connecticut		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H0755	812	0	1	01	01	H0755_812_0	1		1	05/22/2014	2015.01	05/22/2014 09:04:51 AM Central Daylight Time	05/30/2014 04:47:05 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	OXFORD HEALTH PLANS (CT), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H0755	812	0	2015	Connecticut		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H0773	001	0	1	48	05	H0773_001_0	3		1	07/14/2014	2015.01	07/14/2014 10:20:47 AM Central Daylight Time					07/14/2014 10:21:41 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Connect	www.healthallianceconnect.org	Health Alliance Connect (Medicare-Medicaid Plan)	05	48		1			H0773	001	0	2015	Central Illinois		2	500	2			2							www.healthallianceconnect.org	www.healthallianceconnect.org	www.healthallianceconnect.org	(866)951-0264		(866)951-0264		(877)933-8475		(877)933-8475		(866)951-0264		(866)951-0264		(877)933-8475		(877)933-8475		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2
H0809	001	0	1	20	08	H0809_001_0	1		1	05/27/2014	2015.01	05/27/2014 10:27:24 AM Eastern Daylight Time		05/20/2014 10:53:58 AM Eastern Daylight Time			05/27/2014 10:30:25 AM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mercycares.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	001	0	2015	Mercy LIFE		2		2			2								www.mercycares.com	www.mercycares.com									(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318										(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318												
H0809	002	0	1	20	08	H0809_002_0	1		1	05/27/2014	2015.01	05/27/2014 10:28:04 AM Eastern Daylight Time		05/20/2014 10:54:16 AM Eastern Daylight Time			05/27/2014 10:30:25 AM Eastern Daylight Time	MERCY LIFE, INC.	Mercy LIFE	www.mercycares.com	Mercy LIFE, Inc. (PACE)	08	20		1			H0809	002	0	2015	Mercy LIFE		2		2			2								www.mercycares.com	www.mercycares.com									(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318										(800)000-0000		(413)827-4318		(800)000-0000		(413)827-4318												
H0811	001	0	1	49	05	H0811_001_0	5		1	07/24/2014	2015.01	07/24/2014 01:50:17 PM Eastern Daylight Time					07/24/2014 02:08:48 PM Eastern Daylight Time	GUILDNET, INC.	GuildNet Gold Plus FIDA	www.guildnetny.org	GuildNet Gold Plus FIDA Plan (Medicare-Medicaid Plan)	05	49		1			H0811	001	0	2015	Counties: Ki, Qu  Brx, NY, Ri, Wes, Suf, Na		2		2			2							www.guildnetny.org	www.LighthouseGuild.org	www.LighthouseGuild.org	(800)815-0000		(800)815-0000		(800)815-0000		(800)815-0000		(877)444-3973		(877)444-3973		(800)815-0000		(800)815-0000		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)248-0640		(866)248-0640		(800)662-1220		(800)662-1220		2					2					2
H0819	001	0	1	20	08	H0819_001_0	1		1	05/27/2014	2015.01	05/27/2014 01:49:15 PM Eastern Daylight Time		05/22/2014 08:49:01 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE YORK, INC.	York County PACE	http://www.seniorlifeyork.com	Senior LIFE York Dual Eligible (PACE)	08	20		1			H0819	001	0	2015	York County PACE		2	135	2			2								www.seniorlifeyork.com	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H0819	002	0	1	20	08	H0819_002_0	1		1	05/27/2014	2015.01	05/27/2014 09:12:57 AM Eastern Daylight Time		05/22/2014 08:49:01 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE YORK, INC.	York County PACE	http://www.seniorlifeyork.com	Senior LIFE York Medicare Only (PACE)	08	20		1			H0819	002	0	2015	York County PACE Medicare Only		2	4	2			2								www.seniorlifeyork.com	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H0838	020	0	1	01	01	H0838_020_0	13		1	08/04/2014	2015.01	08/04/2014 05:25:05 PM Pacific Daylight Time	08/05/2014 02:54:24 PM Pacific Daylight Time	07/31/2014 02:24:37 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Harmony (HMO SNP)	01	01		1			H0838	020	0	2015	Counties: KER, KIN, LA, ORA, RIV, SBD		2	3639	2			1	4		1		00000000000010000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	024	0	1	01	01	H0838_024_0	14	2	1	08/04/2014	2015.01	08/04/2014 05:24:43 PM Pacific Daylight Time	08/05/2014 02:55:51 PM Pacific Daylight Time	07/31/2014 02:25:04 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Dual Coverage (HMO SNP)	01	01		1			H0838	024	0	2015	Counties:  KER, LA, ORA, RIV, SBD		2	2080	2			1	3		1	3		1	www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	025	0	1	01	01	H0838_025_0	13		1	08/04/2014	2015.01	08/04/2014 05:25:58 PM Pacific Daylight Time	08/05/2014 02:56:20 PM Pacific Daylight Time	07/31/2014 02:25:45 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Classic Care (HMO)	01	01		1			H0838	025	0	2015	Counties:  KER, KIN, LA, ORA, RIV, SBD		2	1619	2			2							www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	026	0	1	01	01	H0838_026_0	13		1	08/04/2014	2015.01	08/04/2014 05:26:42 PM Pacific Daylight Time	08/05/2014 02:56:58 PM Pacific Daylight Time	07/31/2014 02:27:19 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	In Control Drug Savings (HMO SNP)	01	01		1			H0838	026	0	2015	Counties:  KER, LA, ORA, RIV, SBD		2	384	2			1	4		1		00000010000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	027	0	1	01	01	H0838_027_0	13		1	08/04/2014	2015.01	08/04/2014 05:27:28 PM Pacific Daylight Time	08/05/2014 02:57:42 PM Pacific Daylight Time	07/31/2014 02:27:36 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	In Control Extra Care (HMO SNP)	01	01		1			H0838	027	0	2015	Counties:  KER, LA, ORA, RIV, SBD		2	1145	2			1	4		1		00000010000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	028	0	1	01	01	H0838_028_0	13		1	08/04/2014	2015.01	08/04/2014 05:28:09 PM Pacific Daylight Time	08/05/2014 02:58:17 PM Pacific Daylight Time	07/31/2014 02:27:51 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Bridges Drug Savings (HMO SNP)	01	01		1			H0838	028	0	2015	Counties:  KER, LA, ORA, RIV, SBD		2	341	2			1	4		1		00000100000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	029	0	1	01	01	H0838_029_0	14		1	08/04/2014	2015.01	08/04/2014 05:28:52 PM Pacific Daylight Time	08/05/2014 02:58:58 PM Pacific Daylight Time	07/31/2014 02:28:06 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Bridges Extra Care (HMO SNP)	01	01		1			H0838	029	0	2015	Counties:  KER, LA, ORA, RIV, SBD		2	297	2			1	4		1		00000100000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	030	0	1	01	01	H0838_030_0	13		1	08/04/2014	2015.01	08/04/2014 05:29:32 PM Pacific Daylight Time	08/05/2014 02:59:23 PM Pacific Daylight Time	07/31/2014 02:28:20 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Healthy Heart Drug Savings (HMO SNP)	01	01		1			H0838	030	0	2015	Counties: KER, KIN, LA, ORA, RIV, SBD		2	68	2			1	4		1		00001000000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	031	0	1	01	01	H0838_031_0	14		1	08/04/2014	2015.01	08/04/2014 05:30:16 PM Pacific Daylight Time	08/05/2014 02:59:43 PM Pacific Daylight Time	07/31/2014 02:28:35 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Healthy Heart Extra Care (HMO SNP)	01	01		1			H0838	031	0	2015	Counties:  KER, KIN, LA, ORA, RIV, SBD		2	68	2			1	4		1		00001000000000000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0838	032	0	1	01	01	H0838_032_0	13		1	08/04/2014	2015.01	08/04/2014 05:31:00 PM Pacific Daylight Time	08/05/2014 03:00:40 PM Pacific Daylight Time	07/31/2014 02:28:52 PM Pacific Daylight Time			08/06/2014 01:14:17 PM Pacific Daylight Time	UNIVERSAL CARE, INC.	Brand New Day	www.brandnewdayhmo.com	Hope Drug Savings (HMO SNP)	01	01		1			H0838	032	0	2015	Counties: KER, KIN, LA, ORA, RIV, SBD		2	80	2			1	4		1		00000000000010000000		www.brandnewdayhmo.com	www.brandnewdayhmo.com	www.brandnewdayhmo.com	(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)255-4795		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		(866)321-5955		2					2					2
H0839	001	0	1	20	08	H0839_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:47:34 PM Eastern Daylight Time		05/28/2014 12:36:21 PM Eastern Daylight Time			05/28/2014 01:49:22 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	Senior CommUnity Care of North Carolina	www.seniorcommunitycarenc.org	Senior Community Care of North Carolina (PACE)	08	20		1			H0839	001	0	2015	Senior Community Care of North Carolina		2		2			2								www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org									(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000										(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000												
H0839	002	0	1	20	08	H0839_002_0	1		1	05/28/2014	2015.01	05/28/2014 01:48:08 PM Eastern Daylight Time		05/28/2014 12:36:30 PM Eastern Daylight Time			05/28/2014 01:49:22 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	Senior CommUnity Care of North Carolina	www.seniorcommunitycarenc.org	Senior Community Care of North Carolina (PACE)	08	20		1			H0839	002	0	2015	Senior Community Care of North Carolina		2		2			2								www.seniorcommunitycarenc.org	www.seniorcommunitycarenc.org									(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000										(800)000-0000		(919)425-3000		(800)000-0000		(919)425-3000												
H0840	001	0	1	04	01	H0840_001_0	10		1	08/01/2014	2015.01	08/01/2014 02:11:05 PM Pacific Daylight Time	08/04/2014 10:21:35 AM Pacific Daylight Time	07/31/2014 04:10:54 PM Pacific Daylight Time			08/06/2014 08:35:55 AM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycareinc.org	FamilyCare Choice Rx (PPO)	01	04		1			H0840	001	0	2015	Multnomah, Clackamas, Washington, Morrow, Umatilla		2	323	2			2							www.familycarehealthplans.org	www.familycareinc.org	http://www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					
H0840	002	0	1	04	01	H0840_002_0	11		1	07/25/2014	2015.01	07/25/2014 03:29:24 PM Pacific Daylight Time	07/31/2014 02:04:08 PM Pacific Daylight Time				08/04/2014 11:11:21 AM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycareinc.org	FamilyCare Choice (PPO)	01	04		1			H0840	002	0	2015	Multnomah, Clackamas, Washington, Morrow, Umatilla		2	68	2			2							www.familycarehealthplans.org	www.familycareinc.org	http://www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					
H0879	001	0	1	04	01	H0879_001_0	9		1	10/07/2014	2015.01	10/07/2014 02:12:39 PM Central Daylight Time	08/05/2014 04:06:13 PM Central Daylight Time	08/05/2014 04:06:23 PM Central Daylight Time			10/07/2014 05:14:41 PM Central Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Elite (PPO)	01	04		1			H0879	001	0	2015	Northeast Tennessee		2	195	2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		2					2					
H0879	002	0	1	04	01	H0879_002_0	11		1	10/07/2014	2015.01	10/07/2014 02:24:26 PM Central Daylight Time	08/08/2014 08:16:48 AM Central Daylight Time	08/08/2014 08:17:55 AM Central Daylight Time			10/07/2014 05:14:41 PM Central Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Classic (PPO)	01	04		1			H0879	002	0	2015	Northeast Tennessee		2	1608	2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		2					2					
H0879	004	0	1	04	01	H0879_004_0	8		1	10/08/2014	2015.01	10/08/2014 12:16:02 PM Central Daylight Time	09/29/2014 02:34:09 PM Central Daylight Time				10/08/2014 12:16:47 PM Central Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Value (PPO)	01	04		1			H0879	004	0	2015	Northeast Tennessee		2	146	2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298										2					2					
H0879	801	0	1	04	01	H0879_801_0	2		1	05/29/2014	2015.01	05/29/2014 04:31:07 PM Eastern Daylight Time	05/30/2014 07:55:46 PM Eastern Daylight Time				05/30/2014 07:57:44 PM Eastern Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Premier (PPO)	01	04		1			H0879	801	0	2015	National		1	75	2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		2					2					
H0879	802	0	1	04	01	H0879_802_0	2		1	05/29/2014	2015.01	05/29/2014 04:31:55 PM Eastern Daylight Time	05/30/2014 07:55:48 PM Eastern Daylight Time				05/30/2014 07:57:44 PM Eastern Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Choice (PPO)	01	04		1			H0879	802	0	2015	National		1		2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298		2					2					
H0879	803	0	1	04	01	H0879_803_0	2		1	05/29/2014	2015.01	05/29/2014 04:32:27 PM Eastern Daylight Time	05/30/2014 07:55:49 PM Eastern Daylight Time				05/30/2014 07:57:44 PM Eastern Daylight Time	CRESTPOINT HEALTH INSURANCE COMPANY	CrestPoint Health Insurance Company	www.yourcrestpointhealth.com	CrestPoint Health Essential (PPO)	01	04		1			H0879	803	0	2015	National		1		2			2							www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	www.yourcrestpointhealth.com	(888)350-7537		(423)952-2189		(866)828-3307		(423)218-4228										(800)848-0298		(800)848-0298		(800)848-0298		(800)848-0298										2					2					
H0901	004	0	1	01	01	H0901_004_0	6		1	08/02/2014	2015.01	08/02/2014 02:02:53 PM Eastern Daylight Time	08/05/2014 02:50:18 PM Eastern Daylight Time	07/31/2014 05:21:06 PM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H0901	004	0	2015	District of Columbia		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H0901	801	0	1	01	01	H0901_801_0	1		1	05/20/2014	2015.01	05/20/2014 09:14:46 AM Eastern Daylight Time	05/30/2014 12:22:58 PM Eastern Daylight Time				05/31/2014 10:17:38 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H0901	801	0	2015	District of Columbia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H0901	802	0	1	01	01	H0901_802_0	1		1	05/20/2014	2015.01	05/20/2014 09:16:29 AM Eastern Daylight Time	05/30/2014 12:24:44 PM Eastern Daylight Time				05/31/2014 10:17:38 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H0901	802	0	2015	District of Columbia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H0908	001	0	1	01	01	H0908_001_0	8	2	1	08/05/2014	2015.01	08/05/2014 09:37:38 AM Pacific Daylight Time	08/05/2014 03:58:06 PM Pacific Daylight Time	08/05/2014 03:43:38 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Buckeye Health Plan	http://advantage.bchpohio.com	Buckeye Health Plan Advantage (HMO SNP)	01	01		1			H0908	001	0	2015	Northwest, Northeast, Southwest, and Eastern Ohio		2	594	2			1	3		1	2			http://advantage.bchpohio.com	www.bchpohio.com	www.bchpohio.com	(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(866)389-7690		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H0913	002	0	1	01	01	H0913_002_0	6		1	08/04/2014	2015.02	08/04/2014 01:19:10 PM Eastern Daylight Time	08/05/2014 11:19:00 AM Eastern Daylight Time	08/01/2014 11:25:18 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H0913	002	0	2015	Essex, Hudson		2	669	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H0913	012	0	1	01	01	H0913_012_0	6		1	08/05/2014	2015.02	08/05/2014 12:09:30 PM Eastern Daylight Time	08/05/2014 11:19:27 AM Eastern Daylight Time	08/01/2014 11:25:38 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H0913	012	0	2015	Middlesex, Passaic		2	239	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(866)687-8570		(866)687-8570		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H0927	001	0	1	48	05	H0927_001_0	4		1	07/10/2014	2015.01	07/10/2014 03:15:28 PM Central Daylight Time					07/15/2014 08:15:58 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Community MMAI	www.hcsc.com	Blue Medicare Advantage (Medicare-Medicaid Plan)	05	48		1			H0927	001	0	2015	Cook, DuPage, Kane, Kankakee, Lake, and Will ctys		2	10000	2			2								https://myprime.com	www.yourpartd.com	(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(877)723-7702		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	011	0	1	01	01	H1013_011_0	6		1	08/04/2014	2015.01	08/04/2014 03:58:03 PM Eastern Daylight Time	08/04/2014 05:14:10 PM Eastern Daylight Time	07/31/2014 05:21:17 PM Eastern Daylight Time			08/05/2014 12:15:43 PM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Vista Ideal (HMO)	01	01		1			H1013	011	0	2015	South FL		2	3000	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	021	0	1	01	01	H1013_021_0	4		1	08/04/2014	2015.01	08/04/2014 04:39:10 PM Eastern Daylight Time	08/04/2014 05:14:46 PM Eastern Daylight Time	07/31/2014 05:21:28 PM Eastern Daylight Time			08/05/2014 10:54:09 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Vista Ideal (HMO)	01	01		1			H1013	021	0	2015	South FL		2	1275	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	024	0	1	01	01	H1013_024_0	7	2	1	08/04/2014	2015.01	08/04/2014 09:31:10 AM Eastern Daylight Time	08/04/2014 05:15:28 PM Eastern Daylight Time	07/31/2014 05:21:38 PM Eastern Daylight Time			08/05/2014 10:54:09 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Vista Maximum (HMO SNP)	01	01		1			H1013	024	0	2015	South FL		2	500	2			1	3		1	2			http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	029	0	1	01	01	H1013_029_0	4		1	08/04/2014	2015.01	08/04/2014 09:26:49 AM Eastern Daylight Time	08/04/2014 05:16:18 PM Eastern Daylight Time	07/31/2014 05:21:48 PM Eastern Daylight Time			08/05/2014 10:54:09 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Plus (HMO)	01	01		1			H1013	029	0	2015	South FL and Central FL		2	1500	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	030	0	1	01	01	H1013_030_0	9	2	1	08/11/2014	2015.01	08/11/2014 02:04:50 PM Eastern Daylight Time	08/11/2014 11:05:52 AM Eastern Daylight Time	07/31/2014 05:21:59 PM Eastern Daylight Time			08/11/2014 02:05:44 PM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Maximum (HMO SNP)	01	01		1			H1013	030	0	2015	South FL		2	8750	2			1	3		1	2			http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	031	0	1	01	01	H1013_031_0	8		1	08/06/2014	2015.01	08/06/2014 11:23:42 AM Eastern Daylight Time	08/04/2014 05:17:54 PM Eastern Daylight Time	07/31/2014 05:22:10 PM Eastern Daylight Time			08/06/2014 11:24:28 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H1013	031	0	2015	South FL		2	5500	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	032	0	1	01	01	H1013_032_0	6		1	08/05/2014	2015.01	08/05/2014 11:36:58 AM Eastern Daylight Time	08/05/2014 11:00:30 AM Eastern Daylight Time	07/31/2014 05:22:21 PM Eastern Daylight Time			08/05/2014 12:15:43 PM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Plus (HMO)	01	01		1			H1013	032	0	2015	South FL		2	7000	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	033	0	1	01	01	H1013_033_0	5		1	08/04/2014	2015.01	08/04/2014 03:59:58 PM Eastern Daylight Time	08/04/2014 05:19:32 PM Eastern Daylight Time	07/31/2014 05:22:32 PM Eastern Daylight Time			08/05/2014 10:54:09 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H1013	033	0	2015	South FL and North FL		2	6000	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	034	0	1	01	01	H1013_034_0	5	2	1	07/16/2014	2015.01	07/16/2014 01:12:56 PM Eastern Daylight Time	08/04/2014 05:20:24 PM Eastern Daylight Time	07/31/2014 05:22:43 PM Eastern Daylight Time			08/05/2014 10:54:09 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Maximum (HMO SNP)	01	01		1			H1013	034	0	2015	South FL, Central FL and North FL		2	5750	2			1	3		1	2			http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	035	0	1	01	01	H1013_035_0	8		1	08/04/2014	2015.01	08/04/2014 09:35:33 AM Eastern Daylight Time	08/08/2014 04:49:44 PM Eastern Daylight Time	07/31/2014 05:22:54 PM Eastern Daylight Time			08/08/2014 04:50:25 PM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H1013	035	0	2015	Central FL and North FL		2	396	2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1013	802	0	1	01	01	H1013_802_0	2		1	05/29/2014	2015.01	05/29/2014 01:58:12 PM Eastern Daylight Time	07/18/2014 10:47:00 AM Eastern Daylight Time				07/18/2014 11:21:12 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Ideal (HMO)	01	01		1			H1013	802	0	2015	Nationwide		1		2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441		(866)797-8648		(866)797-8648		(855)893-1441		(855)893-1441		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011100111111111111110000100	1	000001011001011111100000000	1					1
H1013	803	0	1	01	01	H1013_803_0	2		1	05/29/2014	2015.01	05/29/2014 01:33:20 PM Eastern Daylight Time	07/18/2014 10:47:24 AM Eastern Daylight Time				07/18/2014 11:21:12 AM Eastern Daylight Time	COVENTRY HEALTH PLAN OF FLORIDA, INC.	Coventry Health Plan of Florida	http://www.chcflorida.coventry-medicare.com	Coventry Summit Value (HMO)	01	01		1			H1013	803	0	2015	Nationwide		1		2			2							http://ProviderDirectory.coventry-medicare.com	http://www.chcflorida-formulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(800)847-3995		(800)847-3995		(855)893-1441		(855)893-1441										(711)-		(711)-		(711)-		(711)-										1	1	011111111011100111111111111110000100	1	000001011001011111100000000	1					1
H1016	001	0	1	01	01	H1016_001_0	9		1	08/06/2014	2015.01	08/06/2014 09:09:34 AM Eastern Daylight Time	08/04/2014 11:44:59 AM Eastern Daylight Time	08/04/2014 01:45:43 PM Eastern Daylight Time			08/06/2014 02:41:26 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	001	0	2015	Miami-Dade County		2	14400	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1016	021	0	1	01	01	H1016_021_0	7		1	08/06/2014	2015.01	08/06/2014 09:09:19 AM Eastern Daylight Time	08/04/2014 11:46:46 AM Eastern Daylight Time	08/04/2014 01:47:06 PM Eastern Daylight Time			08/06/2014 02:41:26 PM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Medicare Choice (HMO)	01	01		1			H1016	021	0	2015	Broward County		2	17500	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1016	801	0	1	01	01	H1016_801_0	3		1	05/12/2014	2015.01	05/12/2014 03:31:28 PM Eastern Daylight Time	06/01/2014 08:03:28 PM Eastern Daylight Time				06/02/2014 11:15:32 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Plan (HMO)	01	01		1			H1016	801	0	2015	AvMed Florida Employer Group Plan		1	20	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1016	802	0	1	01	01	H1016_802_0	3		1	05/12/2014	2015.01	05/12/2014 03:34:00 PM Eastern Daylight Time	06/01/2014 08:04:15 PM Eastern Daylight Time				06/02/2014 11:15:32 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Plan (HMO)	01	01		1			H1016	802	0	2015	AvMed Florida Employer Group Plan		1	20	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003									(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H1016	803	0	1	01	01	H1016_803_0	3		1	05/12/2014	2015.01	05/12/2014 03:36:37 PM Eastern Daylight Time	06/01/2014 08:05:11 PM Eastern Daylight Time				06/02/2014 11:15:32 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MAPD Non-CY Plan (HMO)	01	01		1			H1016	803	0	2015	AvMed Florida  Employer Group Plan		1	20	2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1016	804	0	1	01	01	H1016_804_0	3		1	05/12/2014	2015.01	05/12/2014 03:38:16 PM Eastern Daylight Time	06/01/2014 08:05:55 PM Eastern Daylight Time				06/02/2014 11:15:32 AM Eastern Daylight Time	AVMED, INC.	AvMed Medicare	www.avmed.org	AvMed Employer Group MA Only Non-CY Plan (HMO)	01	01		1			H1016	804	0	2015	AvMed Florida Employer Group Plan		1		2			2							www.avmed.org	www.avmed.org	www.avmed.org	(800)782-8633		(305)671-5437	22147	(800)535-9355		(305)671-5437	21003									(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H1019	001	0	1	01	01	H1019_001_0	4		1	08/02/2014	2015.02	08/02/2014 08:24:40 AM Eastern Daylight Time	08/02/2014 09:17:23 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	001	0	2015	Broward County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	006	0	1	01	01	H1019_006_0	3		1	08/02/2014	2015.02	08/02/2014 08:25:18 AM Eastern Daylight Time	08/02/2014 09:09:03 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	006	0	2015	Miami-Dade County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	010	0	1	01	01	H1019_010_0	3		1	08/02/2014	2015.02	08/02/2014 08:25:57 AM Eastern Daylight Time	08/02/2014 09:34:52 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	010	0	2015	Palm Beach County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	014	0	1	01	01	H1019_014_0	3		1	08/02/2014	2015.02	08/02/2014 08:26:34 AM Eastern Daylight Time	08/02/2014 09:41:03 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	014	0	2015	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	023	0	1	01	01	H1019_023_0	4	2	1	07/11/2014	2015.02	07/11/2014 08:53:25 AM Eastern Daylight Time	08/02/2014 09:22:30 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	023	0	2015	Broward County		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	024	0	1	01	01	H1019_024_0	5	2	1	07/24/2014	2015.02	07/24/2014 02:43:13 PM Eastern Daylight Time	08/02/2014 09:31:41 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	024	0	2015	Miami-Dade County		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	025	0	1	01	01	H1019_025_0	4	2	1	07/11/2014	2015.02	07/11/2014 08:53:41 AM Eastern Daylight Time	08/02/2014 09:45:44 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	025	0	2015	Palm Beach County		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	026	0	1	01	01	H1019_026_0	5	2	1	07/11/2014	2015.02	07/11/2014 08:53:49 AM Eastern Daylight Time	08/02/2014 09:48:31 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	026	0	2015	Hillsborough, Pasco, Pinellas and Polk counties		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	027	0	1	01	01	H1019_027_0	5		1	08/02/2014	2015.02	08/02/2014 08:27:17 AM Eastern Daylight Time	08/02/2014 10:00:51 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	027	0	2015	Lake, Marion and Sumter Counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	028	0	1	01	01	H1019_028_0	5	2	1	07/11/2014	2015.02	07/11/2014 08:53:59 AM Eastern Daylight Time	08/02/2014 10:09:34 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	028	0	2015	Orange, Osceola and Seminole counties		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	032	0	1	01	01	H1019_032_0	5		1	08/02/2014	2015.02	08/02/2014 08:28:01 AM Eastern Daylight Time	08/02/2014 10:05:47 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareDirect (HMO SNP)	01	01		1			H1019	032	0	2015	Broward County		2		2			1	4		1		00000010000000000000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	043	0	1	01	01	H1019_043_0	5		1	08/02/2014	2015.02	08/02/2014 08:32:50 AM Eastern Daylight Time	08/02/2014 10:14:24 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	043	0	2015	Treasure Coast Area		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	054	0	1	01	01	H1019_054_0	3		1	08/02/2014	2015.02	08/02/2014 08:34:19 AM Eastern Daylight Time	08/02/2014 10:17:17 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	054	0	2015	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	057	0	1	01	01	H1019_057_0	3		1	08/02/2014	2015.02	08/02/2014 08:35:06 AM Eastern Daylight Time	08/02/2014 10:23:07 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne PLUS (HMO)	01	01		1			H1019	057	0	2015	Orange, Osceola and Seminole counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	059	0	1	01	01	H1019_059_0	3		1	08/02/2014	2015.02	08/02/2014 08:36:04 AM Eastern Daylight Time	08/02/2014 12:00:15 PM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareDirect (HMO SNP)	01	01		1			H1019	059	0	2015	Hillsborough, Pasco, Pinellas and Polk counties		2		2			1	4		1		00000010000000000000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	060	0	1	01	01	H1019_060_0	5		1	08/02/2014	2015.02	08/02/2014 08:36:57 AM Eastern Daylight Time	08/02/2014 10:37:21 AM Eastern Daylight Time	08/04/2014 05:04:06 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	060	0	2015	Hillsborough, Pasco, Pinellas and Polk counties		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	062	0	1	01	01	H1019_062_0	5		1	08/02/2014	2015.02	08/02/2014 08:37:40 AM Eastern Daylight Time	08/02/2014 10:48:38 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareHeart (HMO SNP)	01	01		1			H1019	062	0	2015	Broward County		2		2			1	4		1		00000000000000010000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	063	0	1	01	01	H1019_063_0	5		1	08/02/2014	2015.02	08/02/2014 08:38:22 AM Eastern Daylight Time	08/02/2014 10:52:14 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareHeart (HMO SNP)	01	01		1			H1019	063	0	2015	Miami-Dade County		2		2			1	4		1		00000000000000010000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	064	0	1	01	01	H1019_064_0	6		1	08/04/2014	2015.02	08/04/2014 12:01:20 PM Eastern Daylight Time	08/04/2014 09:32:27 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareHeart (HMO SNP)	01	01		1			H1019	064	0	2015	Palm Beach County		2		2			1	4		1		00000000000000010000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	065	0	1	01	01	H1019_065_0	3		1	08/02/2014	2015.02	08/02/2014 08:42:31 AM Eastern Daylight Time	08/02/2014 11:07:55 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree (HMO)	01	01		1			H1019	065	0	2015	Palm Beach County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	066	0	1	01	01	H1019_066_0	4		1	08/04/2014	2015.02	08/04/2014 02:42:57 PM Eastern Daylight Time	08/02/2014 01:18:52 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareDirect (HMO SNP)	01	01		1			H1019	066	0	2015	Orange, Osceola and Seminole counties		2		2			1	4		1		00000010000000000000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	067	0	1	01	01	H1019_067_0	3		1	08/02/2014	2015.02	08/02/2014 08:46:20 AM Eastern Daylight Time	08/02/2014 11:20:56 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareDirect (HMO SNP)	01	01		1			H1019	067	0	2015	Lake, Marion, and Sumter counties		2		2			1	4		1		00000010000000000000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	069	0	1	01	01	H1019_069_0	3		1	08/02/2014	2015.02	08/02/2014 08:47:31 AM Eastern Daylight Time	08/02/2014 11:34:06 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareOne (HMO)	01	01		1			H1019	069	0	2015	Duval County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	070	0	1	01	01	H1019_070_0	3		1	08/02/2014	2015.02	08/02/2014 08:48:46 AM Eastern Daylight Time	08/02/2014 11:14:07 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareDirect (HMO SNP)	01	01		1			H1019	070	0	2015	Palm Beach County		2		2			1	4		1		00000010000000000000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	071	0	1	01	01	H1019_071_0	6	2	1	07/11/2014	2015.02	07/11/2014 08:54:47 AM Eastern Daylight Time	08/02/2014 11:19:01 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	071	0	2015	Treasure Coast Area		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	073	0	1	01	01	H1019_073_0	4	2	1	07/11/2014	2015.02	07/11/2014 08:54:55 AM Eastern Daylight Time	08/02/2014 11:37:25 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	073	0	2015	Duval County		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	074	0	1	01	01	H1019_074_0	6	2	1	07/11/2014	2015.02	07/11/2014 08:55:02 AM Eastern Daylight Time	08/02/2014 11:29:12 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareNeeds (HMO SNP)	01	01		1			H1019	074	0	2015	Lake, Marion and Sumter counties		2		2			1	3		1	2			www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	075	0	1	01	01	H1019_075_0	3		1	08/02/2014	2015.02	08/02/2014 08:50:03 AM Eastern Daylight Time	08/02/2014 11:31:23 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareDirect (HMO SNP)	01	01		1			H1019	075	0	2015	Miami-Dade County		2		2			1	4		1		00000010000000000000		www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1019	076	0	1	01	01	H1019_076_0	3		1	08/02/2014	2015.02	08/02/2014 08:50:46 AM Eastern Daylight Time	08/02/2014 11:39:01 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:53:22 AM Eastern Daylight Time	CAREPLUS HEALTH PLANS, INC.	CarePlus Health Plans, Inc.	www.careplushealthplans.com	CareFree PLUS (HMO)	01	01		1			H1019	076	0	2015	Miami-Dade County		2		2			2							www.care-plus-health-plans.com/provider-pharmacy-directories.asp	www.care-plus-health-plans.com/medicare-plans.asp	www.care-plus-health-plans.com/medicare-plans.asp	(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(800)794-5907		(800)794-5907		(800)794-4105		(800)794-4105		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1026	001	0	1	01	01	H1026_001_0	8		1	08/06/2014	2015.01	08/06/2014 02:28:28 PM Eastern Daylight Time	08/06/2014 11:21:17 AM Eastern Daylight Time	07/31/2014 04:07:06 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO LifeTime (HMO)	01	01		1			H1026	001	0	2015	Miami-Dade County		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1026	038	0	1	01	01	H1026_038_0	6		1	08/05/2014	2015.01	08/05/2014 03:37:00 PM Eastern Daylight Time	08/06/2014 08:47:26 AM Eastern Daylight Time	07/31/2014 04:09:47 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO LifeTime (HMO)	01	01		1			H1026	038	0	2015	Palm Beach and Pinellas Counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1026	040	0	1	01	01	H1026_040_0	5		1	08/05/2014	2015.01	08/05/2014 02:13:46 PM Eastern Daylight Time	08/06/2014 08:49:48 AM Eastern Daylight Time	07/31/2014 04:10:32 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO LifeTime (HMO)	01	01		1			H1026	040	0	2015	South, Central and NE counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1026	051	0	1	01	01	H1026_051_0	6		1	08/05/2014	2015.01	08/05/2014 02:25:11 PM Eastern Daylight Time	08/05/2014 10:15:53 PM Eastern Daylight Time	07/31/2014 04:11:18 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicare FL.com	BlueMedicare HMO PrimeTime (HMO)	01	01		1			H1026	051	0	2015	Palm Beach and Pinellas counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1026	055	0	1	01	01	H1026_055_0	5		1	08/06/2014	2015.01	08/06/2014 12:33:31 PM Eastern Daylight Time	08/06/2014 11:24:17 AM Eastern Daylight Time	07/31/2014 04:12:15 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	055	0	2015	Broward County		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1026	056	0	1	01	01	H1026_056_0	5		1	08/05/2014	2015.01	08/05/2014 02:37:51 PM Eastern Daylight Time	08/05/2014 10:47:05 PM Eastern Daylight Time	07/31/2014 04:13:05 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	056	0	2015	Orange, Osceola and Seminole counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1026	057	0	1	01	01	H1026_057_0	5		1	08/05/2014	2015.01	08/05/2014 02:42:54 PM Eastern Daylight Time	08/05/2014 10:23:52 PM Eastern Daylight Time	07/31/2014 04:13:52 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	HEALTH OPTIONS, INC.	Florida Blue HMO	BlueMedicareFL.com	BlueMedicare HMO MyTime (HMO)	01	01		1			H1026	057	0	2015	Hillsborough, Hernando, Pasco and Polk counties		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H1032	002	0	1	02	01	H1032_002_0	5		1	08/04/2014	2015.02	08/04/2014 08:35:17 PM Eastern Daylight Time	08/05/2014 11:19:40 AM Eastern Daylight Time	08/01/2014 11:25:48 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Choice (HMO-POS)	01	02		1			H1032	002	0	2015	Orlando, Jacksonville, PalmBay, Deltona, Sebastian		2	2869	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	025	0	1	02	01	H1032_025_0	6		1	08/06/2014	2015.02	08/06/2014 08:26:57 AM Eastern Daylight Time	08/05/2014 11:19:53 AM Eastern Daylight Time	08/01/2014 11:25:58 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Choice (HMO-POS)	01	02		1			H1032	025	0	2015	Pensacola-Ferry Pass, Ft. Walton Beach		2	955	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	032	0	1	02	01	H1032_032_0	6		1	08/04/2014	2015.02	08/04/2014 08:36:48 PM Eastern Daylight Time	08/05/2014 11:20:07 AM Eastern Daylight Time	08/01/2014 11:26:08 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Dividend (HMO-POS)	01	02		1			H1032	032	0	2015	Tampa-St Petersburg, W Palm Beach, Port St Lucie		2	12233	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	035	0	1	02	01	H1032_035_0	6		1	08/04/2014	2015.02	08/04/2014 08:37:31 PM Eastern Daylight Time	08/05/2014 11:20:20 AM Eastern Daylight Time	08/01/2014 11:26:18 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO-POS)	01	02		1			H1032	035	0	2015	Tampa-St. Petersburg		2	8351	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	037	0	1	01	01	H1032_037_0	7		1	04/23/2014	2015.02	04/23/2014 08:51:34 AM Eastern Daylight Time	05/31/2014 02:06:00 PM Eastern Daylight Time				06/02/2014 03:58:56 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Advance (HMO)	01	01		1			H1032	037	0	2015	51 Counties Statewide		2	593	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794										(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272										2					2					2
H1032	040	0	1	02	01	H1032_040_0	6		1	08/05/2014	2015.02	08/05/2014 10:43:25 AM Eastern Daylight Time	08/05/2014 11:20:33 AM Eastern Daylight Time	08/01/2014 11:26:28 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Dividend (HMO-POS)	01	02		1			H1032	040	0	2015	Miami-Dade County		2	2646	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	061	0	1	01	01	H1032_061_0	7	2	1	07/23/2014	2015.02	07/23/2014 05:12:09 PM Eastern Daylight Time	08/05/2014 11:20:46 AM Eastern Daylight Time	08/01/2014 11:26:38 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Select (HMO SNP)	01	01		1			H1032	061	0	2015	Tampa, Miami, Orlando, W Palm Beach, Ft Lauderdale		2	7392	2			1	3		1	4			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	073	0	1	01	01	H1032_073_0	4		1	08/04/2014	2015.02	08/04/2014 08:39:19 PM Eastern Daylight Time	08/05/2014 11:21:01 AM Eastern Daylight Time	08/01/2014 11:26:48 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H1032	073	0	2015	Ft. Lauderdale, Jacksonville, Bradenton-Sarasota		2	5968	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	079	0	1	01	01	H1032_079_0	4		1	08/04/2014	2015.02	08/04/2014 08:39:48 PM Eastern Daylight Time	08/05/2014 11:21:14 AM Eastern Daylight Time	08/01/2014 11:26:58 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H1032	079	0	2015	Pensacola, Tallahassee, Ft Walton Bch, Panama City		2	2220	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	091	0	1	01	01	H1032_091_0	4		1	08/04/2014	2015.02	08/04/2014 08:40:19 PM Eastern Daylight Time	08/05/2014 11:21:28 AM Eastern Daylight Time	08/01/2014 11:27:08 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H1032	091	0	2015	Orlando, W Palm Bch, Lakeland, Prt St Lucie, Ocala		2	12587	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	124	0	1	01	01	H1032_124_0	8	2	1	07/24/2014	2015.02	07/24/2014 07:28:01 AM Eastern Daylight Time	08/05/2014 11:21:41 AM Eastern Daylight Time	08/01/2014 11:27:18 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1032	124	0	2015	51 Counties Statewide		2	16521	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	133	0	1	02	01	H1032_133_0	7		1	08/04/2014	2015.02	08/04/2014 08:41:10 PM Eastern Daylight Time	08/05/2014 11:21:54 AM Eastern Daylight Time	08/01/2014 11:27:28 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Essential (HMO-POS)	01	02		1			H1032	133	0	2015	FtLauderdale, Bradenton, CapeCoral, PalmBay, Ocala		2	2962	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	170	0	1	01	01	H1032_170_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:28:15 AM Eastern Daylight Time	08/05/2014 11:22:08 AM Eastern Daylight Time	08/01/2014 11:27:38 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1032	170	0	2015	Miami-Dade County		2	261	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	173	0	1	01	01	H1032_173_0	5		1	08/04/2014	2015.02	08/04/2014 08:42:00 PM Eastern Daylight Time	08/05/2014 11:22:21 AM Eastern Daylight Time	08/01/2014 11:27:48 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Essential (HMO)	01	01		1			H1032	173	0	2015	Orlando-Kissimmee		2	9447	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	174	0	1	01	01	H1032_174_0	6		1	08/04/2014	2015.02	08/04/2014 08:42:40 PM Eastern Daylight Time	08/05/2014 11:22:34 AM Eastern Daylight Time	08/01/2014 11:27:58 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Essential (HMO)	01	01		1			H1032	174	0	2015	Tampa-St. Petersburg, Miami		2	5908	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	175	0	1	01	01	H1032_175_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:28:30 AM Eastern Daylight Time	08/05/2014 11:22:48 AM Eastern Daylight Time	08/01/2014 11:28:08 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Liberty (HMO SNP)	01	01		1			H1032	175	0	2015	51 Counties Statewide		2	11459	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	176	0	1	01	01	H1032_176_0	8	2	1	07/24/2014	2015.02	07/24/2014 07:28:39 AM Eastern Daylight Time	08/05/2014 11:23:01 AM Eastern Daylight Time	08/01/2014 11:28:18 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Liberty (HMO SNP)	01	01		1			H1032	176	0	2015	Miami-Dade County		2	289	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(866)637-8041		(866)637-8041		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	177	0	1	01	01	H1032_177_0	4		1	08/04/2014	2015.02	08/04/2014 08:43:08 PM Eastern Daylight Time	08/05/2014 11:23:15 AM Eastern Daylight Time	08/01/2014 11:28:28 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H1032	177	0	2015	Volusia County		2	172	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	179	0	1	01	01	H1032_179_0	4		1	08/04/2014	2015.02	08/04/2014 08:43:52 PM Eastern Daylight Time	08/05/2014 11:23:28 AM Eastern Daylight Time	08/01/2014 11:28:38 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Dividend (HMO)	01	01		1			H1032	179	0	2015	Orlando, WPalmBch, FtLauderdale, PalmBay, Lakeland		2	7055	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	180	0	1	01	01	H1032_180_0	6		1	08/04/2014	2015.02	08/04/2014 08:44:47 PM Eastern Daylight Time	08/05/2014 11:23:42 AM Eastern Daylight Time	08/01/2014 11:28:49 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Dividend (HMO)	01	01		1			H1032	180	0	2015	Select North and Central Florida Counties		2	509	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1032	181	0	1	02	01	H1032_181_0	6		1	05/29/2014	2015.02	05/29/2014 08:24:25 PM Eastern Daylight Time	08/05/2014 11:23:55 AM Eastern Daylight Time	08/01/2014 11:28:59 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF FLORIDA, INC.	WellCare	www.wellcare.com	WellCare Rx (HMO-POS)	01	02		1			H1032	181	0	2015	Jacksonville, Panama City, Tallahasse		2	132	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(888)888-9355		(888)888-9355		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1035	002	0	1	02	01	H1035_002_0	12		1	08/06/2014	2015.01	08/06/2014 09:11:25 AM Eastern Daylight Time	08/06/2014 08:57:44 AM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time			08/06/2014 09:12:06 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP Medvantage Rx Plus (HMO-POS)	01	02		1			H1035	002	0	2015	Flagler, Seminole and Volusia Counties, FL		2	10760	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1035	006	0	1	01	01	H1035_006_0	9		1	07/30/2014	2015.01	07/30/2014 04:31:29 PM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time			08/06/2014 09:13:49 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP Medvantage Rx (HMO)	01	01		1			H1035	006	0	2015	Flagler, Seminole and Volusia Counties, FL		2	2700	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1035	007	0	1	02	01	H1035_007_0	5		1	07/24/2014	2015.01	07/24/2014 04:00:44 PM Eastern Daylight Time	07/14/2014 04:36:02 PM Eastern Daylight Time				07/24/2014 04:29:37 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP Medvantage (HMO-POS)	01	02		1			H1035	007	0	2015	Flagler, Seminole and Volusia Counties, FL		2	220	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771										2					2					2
H1035	009	0	1	01	01	H1035_009_0	7	2	1	08/04/2014	2015.01	08/04/2014 07:19:34 PM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time			08/06/2014 09:15:11 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP Medvantage Dual Access SNP (HMO SNP)	01	01		1			H1035	009	0	2015	Volusia County		2	500	2			1	3		1	2			www.fhcp.com/medicare-directory-dsnp	www.fhcp.com/medicare-formulary-dsnp	www.fhcp.com/medicare-directory-dsnp	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1035	010	0	1	01	01	H1035_010_0	9		1	08/04/2014	2015.01	08/04/2014 07:19:04 PM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time			08/06/2014 09:16:33 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's Premier Plan (HMO)	01	01		1			H1035	010	0	2015	Brevard County		2	500	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1035	011	0	1	02	01	H1035_011_0	10		1	07/30/2014	2015.01	07/30/2014 10:14:28 PM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time	08/06/2014 08:57:47 AM Eastern Daylight Time			08/06/2014 09:17:52 AM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	FHCP's Premier Plus Plan (HMO-POS)	01	02		1			H1035	011	0	2015	Brevard County		2	500	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1035	801	0	1	01	01	H1035_801_0	3		1	05/30/2014	2015.01	05/30/2014 11:22:02 AM Eastern Daylight Time	07/18/2014 04:50:20 PM Eastern Daylight Time				07/18/2014 04:56:08 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	GRPMED (HMO)	01	01		1			H1035	801	0	2015	Florida		1	500	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	1	011111111011100111111111001111000010	1	011111011100111111111010001	1					2
H1035	802	0	1	01	01	H1035_802_0	3		1	05/30/2014	2015.01	05/30/2014 11:22:21 AM Eastern Daylight Time	07/18/2014 04:50:23 PM Eastern Daylight Time				07/18/2014 05:00:16 PM Eastern Daylight Time	FLORIDA HEALTH CARE PLAN, INC.	Florida Health Care Plan, Inc.	www.fhcp.com/fhcp-medicare	GRPMED+ (HMO)	01	01		1			H1035	802	0	2015	Florida		1	500	2			2							www.fhcp.com/medicare-directory	www.fhcp.com/medicare-formulary	www.fhcp.com/medicare-directory	(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(877)615-4022		(386)615-4022		(855)462-3427		(386)676-7110		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		1	1	011111111011100111111111000111000010	1	011111011100111111111010001	1					2
H1036	025	0	1	01	01	H1036_025_0	3		1	08/02/2014	2015.02	08/02/2014 02:44:06 PM Eastern Daylight Time	08/04/2014 03:37:18 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-025 (HMO)	01	01		1			H1036	025	0	2015	Hillsborough County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	040	0	1	01	01	H1036_040_0	3		1	08/02/2014	2015.02	08/02/2014 02:44:43 PM Eastern Daylight Time	08/04/2014 03:36:11 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-040 (HMO)	01	01		1			H1036	040	0	2015	Pasco County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	044	0	1	01	01	H1036_044_0	3		1	08/02/2014	2015.02	08/02/2014 02:45:14 PM Eastern Daylight Time	08/04/2014 03:43:56 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-044 (HMO)	01	01		1			H1036	044	0	2015	Flagler and Volusia counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	052	0	1	01	01	H1036_052_0	3		1	08/02/2014	2015.02	08/02/2014 02:45:44 PM Eastern Daylight Time	08/04/2014 03:36:27 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-052 (HMO)	01	01		1			H1036	052	0	2015	Pinellas County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	053	0	1	01	01	H1036_053_0	2		1	07/10/2014	2015.02	07/10/2014 05:32:43 PM Eastern Daylight Time	07/12/2014 10:50:09 AM Eastern Daylight Time				07/14/2014 01:16:39 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-053A (HMO)	01	01		1			H1036	053	0	2015	Broward County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H1036	054	0	1	01	01	H1036_054_0	4		1	08/02/2014	2015.02	08/02/2014 03:03:11 PM Eastern Daylight Time	08/05/2014 07:41:15 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-054C (HMO)	01	01		1			H1036	054	0	2015	Miami-Dade County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	056	0	1	01	01	H1036_056_0	2		1	07/11/2014	2015.02	07/11/2014 07:18:52 AM Eastern Daylight Time	07/13/2014 12:08:43 PM Eastern Daylight Time				07/14/2014 02:03:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-056 (HMO)	01	01		1			H1036	056	0	2015	Flagler and Volusia counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H1036	062	0	1	01	01	H1036_062_0	3		1	08/02/2014	2015.02	08/02/2014 02:24:15 PM Eastern Daylight Time	08/05/2014 07:47:52 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-062C (HMO)	01	01		1			H1036	062	0	2015	Palm Beach County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	063	0	1	01	01	H1036_063_0	2		1	07/11/2014	2015.02	07/11/2014 01:14:37 PM Eastern Daylight Time	07/09/2014 12:56:26 PM Eastern Daylight Time				07/14/2014 12:41:29 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-063A (HMO)	01	01		1			H1036	063	0	2015	Palm Beach County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H1036	065	0	1	01	01	H1036_065_0	4		1	08/02/2014	2015.02	08/02/2014 03:04:01 PM Eastern Daylight Time	08/05/2014 07:47:09 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-065C (HMO)	01	01		1			H1036	065	0	2015	Broward County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	067	0	1	01	01	H1036_067_0	3		1	08/02/2014	2015.02	08/02/2014 02:46:56 PM Eastern Daylight Time	08/04/2014 03:37:34 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-067 (HMO)	01	01		1			H1036	067	0	2015	Hernando County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	068	0	1	01	01	H1036_068_0	3		1	08/02/2014	2015.02	08/02/2014 02:47:31 PM Eastern Daylight Time	08/04/2014 03:38:07 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-068 (HMO)	01	01		1			H1036	068	0	2015	St Johns, Putnam and Clay counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	074	0	1	01	01	H1036_074_0	4		1	08/02/2014	2015.02	08/02/2014 02:53:23 PM Eastern Daylight Time	08/04/2014 03:37:50 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-074 (HMO)	01	01		1			H1036	074	0	2015	Manatee County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	077	0	1	01	01	H1036_077_0	5	2	1	07/24/2014	2015.02	07/24/2014 02:51:43 PM Eastern Daylight Time	08/05/2014 07:41:37 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-077A (HMO SNP)	01	01		1			H1036	077	0	2015	Miami-Dade County		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	081	0	1	01	01	H1036_081_0	3		1	08/02/2014	2015.02	08/02/2014 02:54:02 PM Eastern Daylight Time	08/04/2014 03:43:39 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-081D (HMO)	01	01		1			H1036	081	0	2015	Baker, Duval and Nassau counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	102	0	1	01	01	H1036_102_0	6	2	1	07/24/2014	2015.02	07/24/2014 04:04:30 PM Eastern Daylight Time	08/04/2014 03:37:01 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-102 (HMO SNP)	01	01		1			H1036	102	0	2015	Tampa Metro Area		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	103	0	1	01	01	H1036_103_0	5	2	1	07/24/2014	2015.02	07/24/2014 02:52:49 PM Eastern Daylight Time	08/05/2014 07:47:32 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-103A (HMO SNP)	01	01		1			H1036	103	0	2015	Broward County		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	104	0	1	01	01	H1036_104_0	3	2	1	07/11/2014	2015.02	07/11/2014 01:18:08 PM Eastern Daylight Time	08/05/2014 07:39:17 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-104A (HMO SNP)	01	01		1			H1036	104	0	2015	Palm Beach County		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	119	0	1	01	01	H1036_119_0	2		1	07/10/2014	2015.02	07/10/2014 01:52:55 PM Eastern Daylight Time	07/13/2014 12:08:25 PM Eastern Daylight Time				07/14/2014 02:27:27 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-119 (HMO)	01	01		1			H1036	119	0	2015	Tampa Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H1036	121	0	1	01	01	H1036_121_0	3		1	08/02/2014	2015.02	08/02/2014 03:05:03 PM Eastern Daylight Time	08/05/2014 07:40:06 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-121C (HMO SNP)	01	01		1			H1036	121	0	2015	Broward County		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	130	0	1	01	01	H1036_130_0	3		1	08/02/2014	2015.02	08/02/2014 02:25:44 PM Eastern Daylight Time	08/05/2014 07:40:29 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-130C (HMO SNP)	01	01		1			H1036	130	0	2015	Palm Beach County		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	137	0	1	01	01	H1036_137_0	3		1	08/02/2014	2015.02	08/02/2014 02:51:28 PM Eastern Daylight Time	08/05/2014 11:17:08 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 09:11:02 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-137 (HMO)	01	01		1			H1036	137	0	2015	Charlotte Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	138	0	1	01	01	H1036_138_0	5		1	08/02/2014	2015.02	08/02/2014 02:59:18 PM Eastern Daylight Time	08/05/2014 11:15:48 AM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-138 (HMO)	01	01		1			H1036	138	0	2015	Greensboro / Winston-Salem Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	140	0	1	01	01	H1036_140_0	4		1	08/02/2014	2015.02	08/02/2014 02:55:10 PM Eastern Daylight Time	08/04/2014 03:38:22 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-140 (HMO)	01	01		1			H1036	140	0	2015	Citrus County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	141	0	1	01	01	H1036_141_0	3		1	08/02/2014	2015.02	08/02/2014 02:55:40 PM Eastern Daylight Time	08/04/2014 03:38:55 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-141 (HMO)	01	01		1			H1036	141	0	2015	Tampa Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	143	0	1	01	01	H1036_143_0	3		1	08/02/2014	2015.02	08/02/2014 02:56:10 PM Eastern Daylight Time	08/04/2014 03:38:39 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-143 (HMO)	01	01		1			H1036	143	0	2015	Escambia and Santa Rosa counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	146	0	1	01	01	H1036_146_0	3		1	08/02/2014	2015.02	08/02/2014 02:56:38 PM Eastern Daylight Time	08/04/2014 03:39:11 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-146 (HMO)	01	01		1			H1036	146	0	2015	Orange, Osceola and Seminole counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	151	0	1	01	01	H1036_151_0	3		1	07/14/2014	2015.02	07/14/2014 08:44:10 AM Eastern Daylight Time	08/02/2014 12:42:46 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-151 (HMO)	01	01		1			H1036	151	0	2015	Jackson Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	153	0	1	01	01	H1036_153_0	3		1	08/04/2014	2015.02	08/04/2014 12:26:44 PM Eastern Daylight Time	08/05/2014 02:20:51 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 08:00:10 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-153 (HMO)	01	01		1			H1036	153	0	2015	Clackamas, Multnomah and Washington counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	156	0	1	01	01	H1036_156_0	5		1	08/02/2014	2015.02	08/02/2014 02:57:11 PM Eastern Daylight Time	08/04/2014 03:39:28 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-156 (HMO SNP)	01	01		1			H1036	156	0	2015	Flagler and Volusia counties		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	157	0	1	01	01	H1036_157_0	3		1	08/02/2014	2015.02	08/02/2014 02:57:38 PM Eastern Daylight Time	08/04/2014 03:40:01 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-157 (HMO)	01	01		1			H1036	157	0	2015	Flagler and Volusia counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	160	0	1	01	01	H1036_160_0	3		1	08/02/2014	2015.02	08/02/2014 02:58:08 PM Eastern Daylight Time	08/04/2014 03:39:44 PM Eastern Daylight Time	08/04/2014 05:04:07 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-160 (HMO SNP)	01	01		1			H1036	160	0	2015	Tampa Metro Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	167	0	1	01	01	H1036_167_0	5	2	1	08/02/2014	2015.02	08/02/2014 04:27:48 PM Eastern Daylight Time	08/05/2014 11:16:07 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-167 (HMO SNP)	01	01		1			H1036	167	0	2015	Charlotte Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	168	0	1	01	01	H1036_168_0	7	2	1	08/02/2014	2015.02	08/02/2014 04:43:17 PM Eastern Daylight Time	08/05/2014 11:16:26 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-168 (HMO SNP)	01	01		1			H1036	168	0	2015	Greensboro / Winston-Salem Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	169	0	1	01	01	H1036_169_0	4	2	1	08/05/2014	2015.02	08/05/2014 12:42:50 PM Eastern Daylight Time	08/05/2014 11:39:34 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-169 (HMO SNP)	01	01		1			H1036	169	0	2015	Gulf Coast Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	170	0	1	01	01	H1036_170_0	3	2	1	08/05/2014	2015.02	08/05/2014 12:43:20 PM Eastern Daylight Time	08/05/2014 11:40:17 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-170 (HMO SNP)	01	01		1			H1036	170	0	2015	Jackson Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	171	0	1	01	01	H1036_171_0	3		1	08/02/2014	2015.02	08/02/2014 03:04:00 PM Eastern Daylight Time	08/02/2014 12:47:59 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-171 (HMO)	01	01		1			H1036	171	0	2015	Gulf Coast Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	175	0	1	01	01	H1036_175_0	3		1	08/02/2014	2015.02	08/02/2014 02:58:40 PM Eastern Daylight Time	08/04/2014 03:40:18 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-175 (HMO SNP)	01	01		1			H1036	175	0	2015	Jacksonville Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	178	0	1	01	01	H1036_178_0	3		1	08/04/2014	2015.02	08/04/2014 12:10:10 PM Eastern Daylight Time	08/02/2014 01:42:46 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-178 (HMO SNP)	01	01		1			H1036	178	0	2015	Gulf Coast Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	179	0	1	01	01	H1036_179_0	3		1	08/02/2014	2015.02	08/02/2014 05:25:47 PM Eastern Daylight Time	08/02/2014 01:43:32 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-179 (HMO SNP)	01	01		1			H1036	179	0	2015	Jackson Metro Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	184	0	1	01	01	H1036_184_0	4		1	08/02/2014	2015.02	08/02/2014 03:06:35 PM Eastern Daylight Time	08/05/2014 11:16:47 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H1036-184 (HMO SNP)	01	01		1			H1036	184	0	2015	Charlotte Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	186	0	1	01	01	H1036_186_0	3		1	08/02/2014	2015.02	08/02/2014 03:05:47 PM Eastern Daylight Time	08/05/2014 07:43:05 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF H1036-186 (HMO SNP)	01	01		1			H1036	186	0	2015	Broward County		2		2			1	4		1		00000000000000010000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	188	0	1	01	01	H1036_188_0	4		1	08/02/2014	2015.02	08/02/2014 03:06:29 PM Eastern Daylight Time	08/05/2014 07:43:27 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-188 (HMO SNP)	01	01		1			H1036	188	0	2015	Miami-Dade County		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	189	0	1	01	01	H1036_189_0	5		1	08/02/2014	2015.02	08/02/2014 03:07:18 PM Eastern Daylight Time	08/05/2014 07:43:48 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF H1036-189 (HMO SNP)	01	01		1			H1036	189	0	2015	Miami-Dade County		2		2			1	4		1		00000000000000010000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	190	0	1	01	01	H1036_190_0	3		1	08/02/2014	2015.02	08/02/2014 02:26:25 PM Eastern Daylight Time	08/05/2014 07:44:10 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF H1036-190 (HMO SNP)	01	01		1			H1036	190	0	2015	Palm Beach County		2		2			1	4		1		00000000000000010000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	193	0	1	01	01	H1036_193_0	3		1	08/02/2014	2015.02	08/02/2014 02:59:11 PM Eastern Daylight Time	08/04/2014 03:40:35 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-193 (HMO SNP)	01	01		1			H1036	193	0	2015	Orange, Osceola and Seminole counties		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	194	0	1	01	01	H1036_194_0	3		1	08/02/2014	2015.02	08/02/2014 02:59:42 PM Eastern Daylight Time	08/04/2014 03:40:52 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1036-194 (HMO SNP)	01	01		1			H1036	194	0	2015	Escambia and Santa Rosa counties		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	196	0	1	01	01	H1036_196_0	4		1	08/02/2014	2015.02	08/02/2014 03:00:11 PM Eastern Daylight Time	08/04/2014 03:41:09 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-196 (HMO)	01	01		1			H1036	196	0	2015	Charlotte County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	199	0	1	01	01	H1036_199_0	3		1	08/02/2014	2015.02	08/02/2014 02:26:57 PM Eastern Daylight Time	08/05/2014 07:44:33 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-199 (HMO)	01	01		1			H1036	199	0	2015	Palm Beach County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	209	0	1	01	01	H1036_209_0	4	2	1	07/11/2014	2015.02	07/11/2014 07:20:55 AM Eastern Daylight Time	08/04/2014 03:41:26 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-209 (HMO SNP)	01	01		1			H1036	209	0	2015	Flagler and Volusia counties		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	210	0	1	01	01	H1036_210_0	4	2	1	07/11/2014	2015.02	07/11/2014 07:21:09 AM Eastern Daylight Time	08/04/2014 03:41:43 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-210 (HMO SNP)	01	01		1			H1036	210	0	2015	Jacksonville Area		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	213	0	1	01	01	H1036_213_0	5	2	1	07/11/2014	2015.02	07/11/2014 07:21:58 AM Eastern Daylight Time	08/04/2014 03:36:44 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-213 (HMO SNP)	01	01		1			H1036	213	0	2015	Orange, Osceola and Seminole counties		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	214	0	1	01	01	H1036_214_0	4	2	1	08/02/2014	2015.02	08/02/2014 05:29:26 PM Eastern Daylight Time	08/04/2014 03:41:59 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-214 (HMO SNP)	01	01		1			H1036	214	0	2015	Escambia and Santa Rosa counties		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	215	0	1	01	01	H1036_215_0	4		1	08/02/2014	2015.02	08/02/2014 03:00:41 PM Eastern Daylight Time	08/04/2014 03:42:15 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-215 (HMO)	01	01		1			H1036	215	0	2015	Sarasota County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	217	0	1	01	01	H1036_217_0	5		1	08/02/2014	2015.02	08/02/2014 03:01:13 PM Eastern Daylight Time	08/04/2014 03:42:32 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-217 (HMO)	01	01		1			H1036	217	0	2015	Lee County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	218	0	1	01	01	H1036_218_0	4		1	08/02/2014	2015.02	08/02/2014 03:01:44 PM Eastern Daylight Time	08/04/2014 03:42:49 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-218 (HMO)	01	01		1			H1036	218	0	2015	Collier County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	219	0	1	01	01	H1036_219_0	3		1	08/04/2014	2015.02	08/04/2014 12:56:16 PM Eastern Daylight Time	08/05/2014 02:23:20 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:00:10 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-219 (HMO)	01	01		1			H1036	219	0	2015	Deschutes County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	222	0	1	01	01	H1036_222_0	3	2	1	08/05/2014	2015.02	08/05/2014 12:43:48 PM Eastern Daylight Time	08/05/2014 11:38:34 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-222 (HMO SNP)	01	01		1			H1036	222	0	2015	DeSoto County		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	223	0	1	01	01	H1036_223_0	3		1	08/02/2014	2015.02	08/02/2014 05:28:27 PM Eastern Daylight Time	08/02/2014 12:48:51 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-223 (HMO)	01	01		1			H1036	223	0	2015	DeSoto County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	226	0	1	01	01	H1036_226_0	6	2	1	07/11/2014	2015.02	07/11/2014 01:31:44 PM Eastern Daylight Time	08/05/2014 07:44:55 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-226 (HMO SNP)	01	01		1			H1036	226	0	2015	Treasure Coast Area		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	227	0	1	01	01	H1036_227_0	3		1	08/02/2014	2015.02	08/02/2014 02:27:38 PM Eastern Daylight Time	08/05/2014 07:45:17 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H1036-227 (HMO SNP)	01	01		1			H1036	227	0	2015	Treasure Coast Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	229	0	1	01	01	H1036_229_0	3		1	08/02/2014	2015.02	08/02/2014 02:30:42 PM Eastern Daylight Time	08/05/2014 07:45:38 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-229 (HMO)	01	01		1			H1036	229	0	2015	Treasure Coast Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	230	0	1	01	01	H1036_230_0	4		1	08/02/2014	2015.02	08/02/2014 03:02:14 PM Eastern Daylight Time	08/04/2014 03:43:23 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-230 (HMO)	01	01		1			H1036	230	0	2015	Hardee, Highlands and Polk counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	231	0	1	01	01	H1036_231_0	6	2	1	08/02/2014	2015.02	08/02/2014 03:02:42 PM Eastern Daylight Time	08/04/2014 03:43:07 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 07:37:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1036-231 (HMO SNP)	01	01		1			H1036	231	0	2015	Hardee, Highlands and Polk counties		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	233	0	1	01	01	H1036_233_0	4		1	08/02/2014	2015.02	08/02/2014 03:29:16 PM Eastern Daylight Time	08/05/2014 11:17:28 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-233 (HMO)	01	01		1			H1036	233	0	2015	Raleigh Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	234	0	1	01	01	H1036_234_0	7		1	08/02/2014	2015.02	08/02/2014 11:58:56 AM Eastern Daylight Time	08/02/2014 08:08:15 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Community HMO SNP-CVD/CHF/DM (HMO SNP)	01	01		1			H1036	234	0	2015	Jefferson County		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	235	0	1	01	01	H1036_235_0	6	2	1	08/02/2014	2015.02	08/02/2014 01:25:59 PM Eastern Daylight Time	08/04/2014 11:55:41 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Community HMO SNP DE (HMO SNP)	01	01		1			H1036	235	0	2015	Jefferson County		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	236	0	1	01	01	H1036_236_0	5		1	08/02/2014	2015.02	08/02/2014 12:04:54 PM Eastern Daylight Time	08/02/2014 08:07:58 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H1036	236	0	2015	Jefferson County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	237	1	1	01	01	H1036_237_1	5		1	08/02/2014	2015.02	08/02/2014 02:31:49 PM Eastern Daylight Time	08/05/2014 07:46:00 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	1	2015	South Florida: Broward or Miami-Dade	South Florida- Broward	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	237	2	1	01	01	H1036_237_2	5		1	08/02/2014	2015.02	08/02/2014 02:32:25 PM Eastern Daylight Time	08/05/2014 07:42:43 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1036-237 (HMO)	01	01		1			H1036	237	2	2015	South Florida: Broward or Miami-Dade	South Florida- Miami-Dade	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1036	801	0	1	01	01	H1036_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:25:48 PM Eastern Daylight Time	07/14/2014 10:42:00 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	801	0	2015	Select counties in Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1036	806	0	1	01	01	H1036_806_0	2		1	05/23/2014	2015.02	05/23/2014 02:26:31 PM Eastern Daylight Time	07/14/2014 10:50:38 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	806	0	2015	Select counties in Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1036	809	0	1	01	01	H1036_809_0	2		1	05/23/2014	2015.02	05/23/2014 02:27:14 PM Eastern Daylight Time	07/14/2014 11:03:18 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	809	0	2015	Select counties in Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1036	810	0	1	01	01	H1036_810_0	2		1	05/23/2014	2015.02	05/23/2014 02:27:56 PM Eastern Daylight Time	07/14/2014 11:09:29 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	810	0	2015	Select Counties in MS and NC		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1036	811	0	1	01	01	H1036_811_0	2		1	05/23/2014	2015.02	05/23/2014 02:28:39 PM Eastern Daylight Time	07/14/2014 11:10:10 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA MEDICAL PLAN, INC.	Humana Medical Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1036	811	0	2015	Select Counties in MS and NC		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1043	001	0	1	20	08	H1043_001_0	1		1	05/23/2014	2015.01	05/23/2014 03:56:36 PM Eastern Daylight Time		05/23/2014 09:48:48 AM Eastern Daylight Time			05/23/2014 03:59:14 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	www.floridapace.org	Florida PACE Centers, Inc. (PACE)	08	20		1			H1043	001	0	2015	Florida PACE Centers, Inc.		2		2			2								www.noformulary.com	www.floridapace.org									(305)262-7842		(305)751-7223		(305)262-7842		(305)751-7223										(305)262-7842		(305)751-7223	2246	(305)262-7842		(305)751-7223												
H1043	002	0	1	20	08	H1043_002_0	1		1	05/23/2014	2015.01	05/23/2014 03:57:12 PM Eastern Daylight Time		05/23/2014 09:58:04 AM Eastern Daylight Time			05/23/2014 03:59:14 PM Eastern Daylight Time	FLORIDA PACE CENTERS, INC.	Florida Pace Centers, Inc.	www.floridapace.org	Florida PACE Centers, Inc (PACE)	08	20		1			H1043	002	0	2015	Florida PACE Centers, Inc.		2		2			2								www.noformulary.com	www.floridapace.org									(305)262-7842	2246	(305)751-7223		(305)262-7842		(305)751-7223										(305)262-7842		(305)751-7223		(305)262-7842		(305)751-7223												
H1045	001	0	1	02	01	H1045_001_0	5		1	07/17/2014	2015.02	07/17/2014 11:06:35 AM Central Daylight Time	08/04/2014 02:38:04 PM Central Daylight Time	07/31/2014 03:12:22 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Choice Dade (HMO-POS)	01	02		1			H1045	001	0	2015	Miami-Dade County		2		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	005	0	1	01	01	H1045_005_0	4		1	07/17/2014	2015.02	07/17/2014 11:07:00 AM Central Daylight Time	08/04/2014 02:38:19 PM Central Daylight Time	07/31/2014 03:12:26 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Choice Broward (HMO)	01	01		1			H1045	005	0	2015	Broward County		2		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	012	0	1	02	01	H1045_012_0	4	2	1	07/18/2014	2015.02	07/18/2014 08:40:43 AM Central Daylight Time	08/04/2014 03:58:33 PM Central Daylight Time	07/31/2014 03:12:30 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Medicare Assist (HMO-POS SNP)	01	02		1			H1045	012	0	2015	Miami-Dade and Broward Counties		2		2			1	3		1	2			www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	016	0	1	01	01	H1045_016_0	4		1	07/17/2014	2015.02	07/17/2014 11:07:29 AM Central Daylight Time	08/04/2014 02:38:34 PM Central Daylight Time	07/31/2014 03:12:35 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Complete Care (HMO)	01	01		1			H1045	016	0	2015	Miami-Dade County		2		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	018	0	1	01	01	H1045_018_0	4		1	07/17/2014	2015.02	07/17/2014 11:08:12 AM Central Daylight Time	08/04/2014 03:58:48 PM Central Daylight Time	07/31/2014 03:12:38 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Special Care Miami-Dade (HMO SNP)	01	01		1			H1045	018	0	2015	Miami-Dade County		2		2			1	4		1		00000000000000000010		www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	023	0	1	01	01	H1045_023_0	4		1	07/21/2014	2015.02	07/21/2014 10:16:03 AM Central Daylight Time	08/04/2014 02:38:49 PM Central Daylight Time	07/31/2014 03:12:41 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.myPreferredCare.com	Preferred Secure Option (HMO)	01	01		1			H1045	023	0	2015	Central Florida		2		2			2							www.myPreferredCare.com	www.myPreferredCare.com	www.myPreferredCare.com	(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(866)231-7201		(866)231-7201		(877)485-5595		(877)485-5595		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	025	0	1	01	01	H1045_025_0	2		1	05/30/2014	2015.02	05/30/2014 04:19:51 PM Central Daylight Time	08/04/2014 02:39:04 PM Central Daylight Time	07/31/2014 03:15:57 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.UHCMedicareSolutions.com	UnitedHealthcare The Villages MedicareComplete (HMO)	01	01		1			H1045	025	0	2015	Lake, Marion and Sumter counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1045	026	0	1	01	01	H1045_026_0	2		1	05/30/2014	2015.02	05/30/2014 04:20:27 PM Central Daylight Time	08/04/2014 02:39:19 PM Central Daylight Time	07/31/2014 03:16:02 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	PREFERRED CARE PARTNERS INC.	Preferred Care Partners, Inc.	www.UHCMedicareSolutions.com	AARP MedicareComplete Focus (HMO)	01	01		1			H1045	026	0	2015	Clay and Duval counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(866)627-7806		(866)627-7806		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1080	004	0	1	01	01	H1080_004_0	2		1	05/30/2014	2015.02	05/30/2014 04:21:06 PM Central Daylight Time	08/04/2014 02:45:33 PM Central Daylight Time	07/31/2014 03:16:06 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1080	004	0	2015	Select counties in Florida		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1080	036	0	1	01	01	H1080_036_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:01:22 AM Central Daylight Time	08/04/2014 03:59:29 PM Central Daylight Time	07/31/2014 03:16:09 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H1080	036	0	2015	Tampa metro area		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1080	042	0	1	01	01	H1080_042_0	2		1	05/30/2014	2015.02	05/30/2014 04:21:27 PM Central Daylight Time	08/04/2014 02:45:48 PM Central Daylight Time	07/31/2014 03:16:12 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1080	042	0	2015	St. Lucie County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1080	043	0	1	01	01	H1080_043_0	2		1	05/30/2014	2015.02	05/30/2014 04:22:53 PM Central Daylight Time	08/04/2014 02:46:04 PM Central Daylight Time	07/31/2014 03:17:13 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1080	043	0	2015	Brevard, Orange, Osceola, and Seminole counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1080	801	0	1	01	01	H1080_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:05:01 AM Central Daylight Time	05/30/2014 04:52:52 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1080	801	0	2015	Select Counties in Florida		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1080	804	0	1	01	01	H1080_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:05:10 AM Central Daylight Time	05/30/2014 04:53:12 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1080	804	0	2015	Select Counties in Florida		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H1080	807	0	1	01	01	H1080_807_0	1		1	05/22/2014	2015.01	05/22/2014 09:05:18 AM Central Daylight Time	05/30/2014 04:53:32 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1080	807	0	2015	Select Counties in Florida		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1080	808	0	2	01	01	H1080_808_0	1		1	05/22/2014	2015.01	05/22/2014 09:05:27 AM Central Daylight Time	05/30/2014 04:53:52 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF FLORIDA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1080	808	0	2015	Select Counties in Florida		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1099	001	0	1	02	01	H1099_001_0	5		1	07/24/2014	2015.01	07/24/2014 10:38:42 AM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time			08/05/2014 02:59:45 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myHFHP.org	Health First Classic Plan (HMO-POS)	01	02		1			H1099	001	0	2015	Brevard and Indian River Counties		2	12356	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1099	006	0	1	01	01	H1099_006_0	5		1	07/24/2014	2015.01	07/24/2014 10:38:10 AM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time			08/05/2014 02:59:45 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myHFHP.org	Health First Value Plan (HMO)	01	01		1			H1099	006	0	2015	Brevard and Indian River Counties		2	61092	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1099	009	0	1	01	01	H1099_009_0	5		1	07/24/2014	2015.01	07/24/2014 10:37:38 AM Eastern Daylight Time	06/01/2014 03:44:12 PM Eastern Daylight Time				07/24/2014 11:02:48 AM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myHFHP.org	Health First Secure Plan (HMO)	01	01		1			H1099	009	0	2015	Brevard and Indian River Counties		2	1944	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771										2					2					2
H1099	014	0	1	01	01	H1099_014_0	6		1	08/05/2014	2015.01	08/05/2014 02:49:10 PM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time			08/05/2014 02:59:45 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myHFHP.org	Health First Rewards Plan (HMO)	01	01		1			H1099	014	0	2015	Brevard and Indian River Counties		2	9900	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1099	016	0	1	02	01	H1099_016_0	4		1	08/05/2014	2015.01	08/05/2014 11:33:33 AM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time			08/05/2014 02:59:45 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myFHCA.org	Florida Hospital SunSaver Plan (HMO-POS)	01	02		1			H1099	016	0	2015	Volusia, Flagler, Hardee, and Highlands Counties		2	16482	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1099	017	0	1	02	01	H1099_017_0	5		1	07/24/2014	2015.01	07/24/2014 10:35:53 AM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time	08/05/2014 01:34:30 PM Eastern Daylight Time			08/05/2014 02:59:45 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myFHCA.org	Florida Hospital Explorer Plan (HMO-POS)	01	02		1			H1099	017	0	2015	Volusia, Flagler, Hardee, and Highlands Counties		2	8963	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(855)882-6467		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1099	802	0	1	01	01	H1099_802_0	1		1	06/01/2014	2015.01	06/01/2014 08:19:31 PM Eastern Daylight Time	06/01/2014 08:32:08 PM Eastern Daylight Time				06/01/2014 08:41:11 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myHFHP.org	EMPLOYER GROUP PLUS (HMO)	01	01		1			H1099	802	0	2015	Central Florida Area		1	1675	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1099	804	0	1	02	01	H1099_804_0	1		1	06/01/2014	2015.01	06/01/2014 08:06:06 PM Eastern Daylight Time	06/01/2014 08:35:12 PM Eastern Daylight Time				06/01/2014 08:41:11 PM Eastern Daylight Time	HEALTH FIRST HEALTH PLANS	Health First Health Plans, Inc.	www.myHFHP.org	EMPLOYER GROUP POS (HMO-POS)	01	02		1			H1099	804	0	2015	Central Florida Area		1	2300	2			2							www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	www.HealthFirstHealthPlans.org	(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)716-7737		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H1108	001	0	1	04	01	H1108_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:24:31 AM Central Daylight Time	08/04/2014 05:55:32 PM Central Daylight Time	07/31/2014 03:17:17 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H1108	001	0	2015	Atlanta and Macon Metro areas		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1108	002	0	1	04	01	H1108_002_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:01:31 AM Central Daylight Time	08/04/2014 03:59:54 PM Central Daylight Time	07/31/2014 03:17:20 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H1108	002	0	2015	Atlanta and Macon Metro Areas		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1109	005	0	1	01	01	H1109_005_0	5		1	08/02/2014	2015.01	08/02/2014 01:15:04 PM Eastern Daylight Time	08/04/2014 05:19:38 PM Eastern Daylight Time	07/31/2014 05:23:04 PM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH INC.(GEORGIA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H1109	005	0	2015	Atlanta and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1109	801	0	1	01	01	H1109_801_0	1		1	05/20/2014	2015.01	05/20/2014 09:21:14 AM Eastern Daylight Time	05/30/2014 10:11:14 AM Eastern Daylight Time				05/31/2014 10:17:38 AM Eastern Daylight Time	AETNA HEALTH INC.(GEORGIA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1109	801	0	2015	Georgia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H1109	802	0	1	01	01	H1109_802_0	1		1	05/20/2014	2015.01	05/20/2014 09:22:55 AM Eastern Daylight Time	05/30/2014 10:14:00 AM Eastern Daylight Time				05/31/2014 10:17:38 AM Eastern Daylight Time	AETNA HEALTH INC.(GEORGIA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H1109	802	0	2015	Georgia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H1111	006	0	1	01	01	H1111_006_0	2		1	05/30/2014	2015.02	05/30/2014 04:23:33 PM Central Daylight Time	08/04/2014 02:33:41 PM Central Daylight Time	07/31/2014 03:17:57 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H1111	006	0	2015	Select counties in Georgia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1111	801	0	1	01	01	H1111_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:05:42 AM Central Daylight Time	05/30/2014 04:54:50 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	801	0	2015	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1111	804	0	1	01	01	H1111_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:05:52 AM Central Daylight Time	05/30/2014 04:55:10 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	804	0	2015	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H1111	805	0	1	01	01	H1111_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:06:01 AM Central Daylight Time	05/30/2014 04:55:29 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H1111	805	0	2015	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1111	807	0	2	01	01	H1111_807_0	1		1	05/22/2014	2015.01	05/22/2014 09:06:09 AM Central Daylight Time	05/30/2014 04:55:48 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE OF GEORGIA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H1111	807	0	2015	GA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H1112	006	0	1	01	01	H1112_006_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:28:55 AM Eastern Daylight Time	08/05/2014 11:24:09 AM Eastern Daylight Time	08/01/2014 11:29:09 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1112	006	0	2015	Atlanta, Augusta, Savannah, Columbus, Brunswick		2	14314	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)482-3361		(866)482-3361		(877)817-5794		(877)817-5794		(866)482-3361		(866)482-3361		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1112	027	0	1	01	01	H1112_027_0	7		1	08/04/2014	2015.02	08/04/2014 01:13:02 PM Eastern Daylight Time	08/05/2014 11:24:22 AM Eastern Daylight Time	08/01/2014 11:29:19 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF GEORGIA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H1112	027	0	2015	Atlanta, Augusta, Savannah, Columbus, Brunswick		2	21463	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)334-7730		(866)334-7730		(877)817-5794		(877)817-5794		(866)334-7730		(866)334-7730		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1170	002	0	1	01	01	H1170_002_0	7		1	08/06/2014	2015.01	08/06/2014 11:44:00 AM Eastern Daylight Time	08/05/2014 05:17:21 PM Eastern Daylight Time	08/04/2014 02:26:18 PM Eastern Daylight Time			08/06/2014 02:27:21 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1170	002	0	2015	Atlanta Metro Area		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1170	008	0	1	01	01	H1170_008_0	7	2	1	07/23/2014	2015.01	07/23/2014 03:09:47 PM Eastern Daylight Time	08/04/2014 03:37:29 PM Eastern Daylight Time	08/04/2014 03:12:35 PM Eastern Daylight Time			08/06/2014 02:27:21 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Senior Advantage Medicare Medicaid Plan (HMO SNP)	01	01		1			H1170	008	0	2015	Atlanta Metro Area		2		2			1	3		1	2			kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1170	009	0	1	01	01	H1170_009_0	6		1	08/06/2014	2015.01	08/06/2014 02:13:44 PM Eastern Daylight Time	08/05/2014 05:19:53 PM Eastern Daylight Time	08/04/2014 02:30:07 PM Eastern Daylight Time			08/06/2014 02:27:21 PM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1170	009	0	2015	Atlanta Metro Area		2		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(800)232-4404		(800)232-4404		(877)408-3493		(877)408-3493		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1170	801	0	1	01	01	H1170_801_0	3		1	05/23/2014	2015.01	05/23/2014 03:21:00 PM Eastern Daylight Time	07/02/2014 02:57:52 PM Eastern Daylight Time				07/14/2014 10:43:29 AM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Employer Group Plan (HMO)	01	01		1			H1170	801	0	2015	Atlanta Metro Area		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404										(711)-		(711)-		(711)-		(711)-										1	1	011111111000000000111110011100000010	1	000000111011010000000000001	1					2
H1170	802	0	1	01	01	H1170_802_0	3		1	05/23/2014	2015.01	05/23/2014 03:23:10 PM Eastern Daylight Time	07/02/2014 03:11:40 PM Eastern Daylight Time				07/14/2014 10:43:29 AM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	Kaiser Employer Group With Part D (HMO)	01	01		1			H1170	802	0	2015	Atlanta Metro Area		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000000001111110011100000010	1	000000111011010000000000001	1					2
H1170	805	0	1	01	01	H1170_805_0	3		1	05/23/2014	2015.01	05/23/2014 03:23:44 PM Eastern Daylight Time	07/02/2014 04:52:12 PM Eastern Daylight Time				07/14/2014 10:43:29 AM Eastern Daylight Time	KAISER FOUNDATION HP OF GA, INC.	Kaiser Permanente	kp.org/medicare	FEHB Part AB  with D (HMO)	01	01		1			H1170	805	0	2015	Atlanta Metro Area		1		2			2							kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(800)232-4404		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000000001111110011100000010	1	000000111011010000000000001	1					2
H1181	001	0	1	07	02	H1181_001_0	5		2	07/21/2014	2015.01	07/21/2014 02:17:29 PM Central Daylight Time			06/02/2014 08:07:09 PM Central Daylight Time		07/21/2014 02:54:21 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.NetworkHealthMedicare.com	Network Prime (MSA)	02	07	2	1			H1181	001	0	2015	Wisconsin		2	371	2			2										(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529																				
H1189	001	0	1	01	01	H1189_001_0	9		1	08/06/2014	2015.01	08/06/2014 02:24:18 PM US Mountain Standard Time	08/06/2014 02:31:51 PM US Mountain Standard Time	08/06/2014 02:34:11 PM US Mountain Standard Time			08/06/2014 02:40:30 PM US Mountain Standard Time	CHRISTUS HEALTH PLAN	CHRISTUS Health Plan New Mexico	www.christushealthplan.org	Christus Health Plan (HMO)	01	01		1			H1189	001	0	2015	Santa Fe, San Miguel, Los Alamos		2	800	2			2								www.christushealthplan.org	www.christushealthplan.org	(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		(800)678-7347		2					2					2
H1230	001	0	1	01	01	H1230_001_0	6		1	07/23/2014	2015.01	07/23/2014 07:48:47 AM Hawaiian Standard Time	08/02/2014 03:29:38 PM Hawaiian Standard Time	08/04/2014 01:34:47 PM Hawaiian Standard Time			08/06/2014 06:34:51 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Enhanced (HMO)	01	01		1			H1230	001	0	2015	Islands of Oahu and Maui		2		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1230	003	0	1	01	01	H1230_003_0	5		1	08/05/2014	2015.01	08/05/2014 01:28:54 PM Hawaiian Standard Time	08/05/2014 10:16:55 AM Hawaiian Standard Time	08/04/2014 01:36:50 PM Hawaiian Standard Time			08/06/2014 06:34:51 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H1230	003	0	2015	Islands of Oahu and Maui		2		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1230	005	0	1	01	01	H1230_005_0	5		1	07/23/2014	2015.01	07/23/2014 07:49:28 AM Hawaiian Standard Time	08/05/2014 03:31:57 PM Hawaiian Standard Time	08/04/2014 01:39:37 PM Hawaiian Standard Time			08/06/2014 06:34:51 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Essential (HMO)	01	01		1			H1230	005	0	2015	Island of Hawaii except for 3 ZIPs		2		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1230	006	0	1	01	01	H1230_006_0	5		1	07/23/2014	2015.01	07/23/2014 07:49:46 AM Hawaiian Standard Time	08/02/2014 03:49:50 PM Hawaiian Standard Time	08/04/2014 01:46:14 PM Hawaiian Standard Time			08/06/2014 06:34:51 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Senior Advantage Essential Plus (HMO)	01	01		1			H1230	006	0	2015	Island of Hawaii except for 3 ZIPs		2		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(800)805-2739		(800)805-2739		(877)408-3494		(877)408-3494		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1230	801	0	1	01	01	H1230_801_0	3		1	05/27/2014	2015.01	05/27/2014 07:27:24 AM Hawaiian Standard Time	07/03/2014 04:12:20 PM Hawaiian Standard Time				07/14/2014 11:07:14 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Employer Group MA only (HMO)	01	01		1			H1230	801	0	2015	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739										(711)-		(711)-		(711)-		(711)-										1	1	001111111100000000000001001100000010	1	111111111111011111111111111	1					2
H1230	803	0	1	01	01	H1230_803_0	3		1	05/31/2014	2015.01	05/31/2014 04:57:33 PM Hawaiian Standard Time	07/03/2014 04:13:37 PM Hawaiian Standard Time				07/14/2014 11:07:14 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Employer Group MA-PD (HMO)	01	01		1			H1230	803	0	2015	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	001111111100000000000001001100000010	1	111111111111011111111111111	1					2
H1230	804	0	2	01	01	H1230_804_0	5		1	06/01/2014	2015.01	06/01/2014 12:07:46 PM Pacific Daylight Time	07/03/2014 04:15:20 PM Hawaiian Standard Time				07/15/2014 01:12:07 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	Kaiser Permanente Employer Group MA-PD Part B (HMO)	01	01		2	1		H1230	804	0	2015	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	001111111100000000000001001100000010	1	111111111111011111111111111	1					2
H1230	805	0	1	01	01	H1230_805_0	3		1	05/14/2014	2015.01	05/14/2014 09:06:00 AM Hawaiian Standard Time	07/03/2014 04:17:01 PM Hawaiian Standard Time				07/14/2014 11:07:14 AM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H1230	805	0	2015	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	001111111100000000000001001100000010	1	111111111111011111111111111	1					2
H1230	806	0	2	01	01	H1230_806_0	4		1	06/01/2014	2015.01	06/01/2014 12:08:06 PM Pacific Daylight Time	07/03/2014 04:19:03 PM Hawaiian Standard Time				07/15/2014 01:12:07 PM Hawaiian Standard Time	KAISER FOUNDATION HP, INC.	Kaiser Permanente	www.kp.org/medicare	FEHB B only with D (HMO)	01	01		2	1		H1230	806	0	2015	Islands of Oahu, Maui and Hawaii except for 3 ZIPs		1		2			2							www.kp.org/medicare	www.kp.org/seniorrx	www.kp.org/seniorrx	(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(800)805-2739		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	001111111100000000000001001100000010	1	111111111111011111111111111	1					2
H1234	001	0	1	20	08	H1234_001_0	1		1	05/20/2014	2015.01	05/20/2014 01:15:10 PM Eastern Daylight Time		05/19/2014 04:00:49 PM Eastern Daylight Time			05/20/2014 01:18:08 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Dual (PACE)	08	20		1			H1234	001	0	2015	Mercer County and portions of Burlington County		2		2			2								www.stfrancismedical.org	www.carekinesis.com									(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474										(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474												
H1234	002	0	1	20	08	H1234_002_0	1		1	05/20/2014	2015.01	05/20/2014 01:16:12 PM Eastern Daylight Time		05/19/2014 04:03:21 PM Eastern Daylight Time			05/20/2014 01:18:08 PM Eastern Daylight Time	LIFE ST. FRANCIS	LIFE St. Francis	www.stfrancismedical.org/LIFE	SFMC-Medicare only (PACE)	08	20		1			H1234	002	0	2015	Mercer County and portions of Burlington County		2		2			2								www.stfrancismedical.org	www.carekinesis.com									(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474										(609)599-5474		(609)599-5474		(609)599-5474		(609)599-5474												
H1239	001	0	1	20	08	H1239_001_0	1		1	05/21/2014	2015.01	05/21/2014 04:20:05 PM Eastern Daylight Time		05/21/2014 04:12:41 PM Eastern Daylight Time			05/21/2014 04:22:38 PM Eastern Daylight Time	KISSITO PACE OF ROANOKE, INC.	Kissito PACE Marketing	www.kissitopace.org	Kissito PACE Part D (PACE)	08	20		1			H1239	001	0	2015	Kissito PACE of Roanoke, INC.		2		2			2								www.kissito.org	www.seniorscript.com									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113											
H1239	002	0	1	20	08	H1239_002_0	1		1	05/21/2014	2015.01	05/21/2014 04:20:43 PM Eastern Daylight Time		05/21/2014 04:12:32 PM Eastern Daylight Time			05/21/2014 04:22:38 PM Eastern Daylight Time	KISSITO PACE OF ROANOKE, INC.	Kissito PACE Marketing	www.KissitoPACE.org	Kissito PACE (PACE)	08	20		1			H1239	002	0	2015	Kissito PACE of Roanoke INC.		2		2			2								www.kissito.org	www.seniorscript.com									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113									(540)904-2817	113	(540)904-2817	113	(540)904-2817	113	(540)904-2817	113											
H1264	004	0	1	02	01	H1264_004_0	6		1	08/04/2014	2015.02	08/04/2014 01:21:29 PM Eastern Daylight Time	08/05/2014 11:24:35 AM Eastern Daylight Time	08/01/2014 11:29:29 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com	WellCare Value (HMO-POS)	01	02		1			H1264	004	0	2015	Houston, Dallas, San Antonio, Fort Worth, El Paso		2	8759	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1264	007	0	1	01	01	H1264_007_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:32:07 AM Eastern Daylight Time	08/05/2014 11:24:48 AM Eastern Daylight Time	08/01/2014 11:29:40 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1264	007	0	2015	Houston, Dallas, San Antonio, Fort Worth, Beaumont		2	13361	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)530-9495		(866)530-9495		(877)817-5794		(877)817-5794		(866)530-9495		(866)530-9495		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1264	008	0	1	01	01	H1264_008_0	8		1	09/11/2014	2015.02	09/11/2014 01:00:59 PM Eastern Daylight Time	08/05/2014 11:25:02 AM Eastern Daylight Time	08/01/2014 11:29:52 AM Eastern Daylight Time			09/12/2014 10:07:23 AM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com	WellCare Dividend (HMO)	01	01		1			H1264	008	0	2015	Houston, Dallas, San Antonio, Fort Worth, El Paso		2	16234	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(866)687-8878		(866)687-8878		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1264	018	0	1	01	01	H1264_018_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:32:27 AM Eastern Daylight Time	08/05/2014 11:25:16 AM Eastern Daylight Time	08/01/2014 11:30:03 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WELLCARE OF TEXAS, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1264	018	0	2015	El Paso County		2	989	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)530-9495		(866)530-9495		(877)817-5794		(877)817-5794		(866)530-9495		(866)530-9495		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1286	002	0	1	01	01	H1286_002_0	4		1	05/30/2014	2015.02	05/30/2014 04:28:15 PM Central Daylight Time	08/04/2014 02:34:41 PM Central Daylight Time	07/31/2014 03:18:02 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1286	002	0	2015	Spokane County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1286	003	0	1	01	01	H1286_003_0	2		1	05/27/2014	2015.02	05/27/2014 06:20:23 PM Central Daylight Time	05/30/2014 04:57:23 PM Central Daylight Time				05/31/2014 10:35:47 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H1286	003	0	2015	Spokane County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H1286	009	0	1	01	01	H1286_009_0	4		1	05/30/2014	2015.02	05/30/2014 04:28:24 PM Central Daylight Time	08/04/2014 02:35:06 PM Central Daylight Time	07/31/2014 03:18:06 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1286	009	0	2015	Spokane County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1291	001	0	1	09	04	H1291_001_0	3		1	07/10/2014	2015.02	07/10/2014 01:58:20 PM Eastern Daylight Time	08/04/2014 11:38:08 AM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Gold Choice H1291-001 (PFFS)	04	09	1	1			H1291	001	0	2015	Select Counties in New York		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1302	001	0	1	04	01	H1302_001_0	6		1	08/01/2014	2015.01	08/01/2014 11:30:02 AM Mountain Daylight Time	08/04/2014 11:34:20 AM Mountain Daylight Time	08/04/2014 11:34:21 AM Mountain Daylight Time			08/04/2014 02:20:07 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Idaho (PPO)	01	04		1			H1302	001	0	2015	Select Counties in Idaho		2	6186	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					
H1302	004	0	1	04	01	H1302_004_0	3		1	07/17/2014	2015.01	07/17/2014 02:55:15 PM Mountain Daylight Time	07/08/2014 01:24:56 PM Mountain Daylight Time				07/18/2014 10:07:59 AM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue (PPO)	01	04		1			H1302	004	0	2015	Select Counties in Idaho		2	633	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2					
H1302	006	0	1	04	01	H1302_006_0	6		1	08/01/2014	2015.01	08/01/2014 11:31:30 AM Mountain Daylight Time	08/04/2014 11:34:21 AM Mountain Daylight Time	08/04/2014 11:34:11 AM Mountain Daylight Time			08/04/2014 02:20:07 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	Secure Blue Treasure Valley (PPO)	01	04		1			H1302	006	0	2015	Ada, Boise, Canyon, Gem and Owyhee Counties		2	2450	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					
H1303	001	0	1	04	01	H1303_001_0	4		1	05/30/2014	2015.02	05/30/2014 04:28:38 PM Central Daylight Time	08/04/2014 02:37:56 PM Central Daylight Time	07/31/2014 03:18:10 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1303	001	0	2015	Ada and Canyon counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1303	007	0	1	04	01	H1303_007_0	4		1	05/30/2014	2015.02	05/30/2014 04:28:47 PM Central Daylight Time	08/04/2014 02:38:21 PM Central Daylight Time	07/31/2014 03:18:15 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H1303	007	0	2015	Ada and Canyon counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1304	001	0	1	04	01	H1304_001_0	8		1	07/14/2014	2015.01	07/14/2014 02:29:20 PM Mountain Daylight Time	06/27/2014 02:06:17 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H1304	001	0	2015	Select Counties in Idaho/Asotin Co, WA		2	2316	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H1304	002	0	1	04	01	H1304_002_0	9		1	08/04/2014	2015.01	08/04/2014 04:58:26 PM Mountain Daylight Time	08/05/2014 10:25:06 AM Pacific Daylight Time	08/01/2014 08:23:34 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	002	0	2015	Select Counties in Idaho/Asotin Co, WA		2	2316	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1304	004	0	1	04	01	H1304_004_0	9		1	07/14/2014	2015.01	07/14/2014 02:31:45 PM Mountain Daylight Time	08/05/2014 10:25:20 AM Pacific Daylight Time	08/01/2014 08:23:58 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H1304	004	0	2015	Select Counties in Idaho/Asotin Co, WA		2	1423	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1304	008	0	1	04	01	H1304_008_0	8		1	07/14/2014	2015.01	07/14/2014 02:29:34 PM Mountain Daylight Time	06/27/2014 02:07:15 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H1304	008	0	2015	Ada, Boise, Canyon, Gem, and Owyhee counties		2	262	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H1304	009	0	1	04	01	H1304_009_0	9		1	08/04/2014	2015.01	08/04/2014 04:59:15 PM Mountain Daylight Time	08/05/2014 10:25:32 AM Pacific Daylight Time	08/01/2014 08:24:22 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H1304	009	0	2015	Ada, Boise, Canyon, Gem, and Owyhee counties		2	2316	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1304	010	0	1	04	01	H1304_010_0	9		1	07/14/2014	2015.01	07/14/2014 02:31:58 PM Mountain Daylight Time	08/05/2014 10:25:44 AM Pacific Daylight Time	08/01/2014 08:24:44 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H1304	010	0	2015	Ada, Boise, Canyon, Gem, and Owyhee counties		2	1444	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1304	803	0	1	04	01	H1304_803_0	8		1	07/09/2014	2015.01	07/09/2014 05:34:11 PM Mountain Daylight Time	06/27/2014 02:08:30 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H1304	803	0	2015	Nationwide except territories		1	1000	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										2					2					
H1304	804	0	1	04	01	H1304_804_0	8		1	07/09/2014	2015.01	07/09/2014 05:34:30 PM Mountain Daylight Time	06/30/2014 06:38:18 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield Of Idaho	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H1304	804	0	2015	Nationwide except territories		1	1000	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1310	001	0	1	20	08	H1310_001_0	1		1	05/29/2014	2015.01	05/29/2014 11:07:38 AM Eastern Daylight Time		05/28/2014 12:46:29 PM Eastern Daylight Time			05/29/2014 11:09:47 AM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	CentraCare	www.mycentracare.com	CentraCare Dual (PACE)	08	20		1			H1310	001	0	2015	Calhoun, Kalamazoo, and VanBuren Counties		2		2			2								mycentracare.com	mycentracare.com									(877)284-4071		(269)441-9332		(877)284-4071		(269)441-9300										(800)649-3777		(269)441-9329		(800)649-3777		(269)441-9329												
H1310	003	0	1	20	08	H1310_003_0	1		1	05/29/2014	2015.01	05/29/2014 11:08:13 AM Eastern Daylight Time		05/28/2014 12:52:32 PM Eastern Daylight Time			05/29/2014 11:09:47 AM Eastern Daylight Time	COMPREHENSIVE SENIOR CARE CORPORATION	CentraCare	www.mycentracare.com	CentraCare Medicare-only (PACE)	08	20		1			H1310	003	0	2015	Calhoun, Kalamazoo, and VanBuren Counties		2		2			2								mycentracare.com	mycentracare.com									(877)284-4071		(269)441-9332		(877)284-4071		(269)441-9300										(800)649-3777		(269)441-9329		(800)649-3777		(269)441-9329												
H1350	001	0	1	02	01	H1350_001_0	5		1	08/01/2014	2015.01	08/01/2014 11:37:47 AM Mountain Daylight Time	08/04/2014 11:34:12 AM Mountain Daylight Time	08/04/2014 11:34:13 AM Mountain Daylight Time			08/04/2014 02:20:07 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Rx Option I (HMO-POS)	01	02		1			H1350	001	0	2015	Select Counties in Idaho		2	10280	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2
H1350	006	0	1	01	01	H1350_006_0	4		1	07/22/2014	2015.01	07/22/2014 10:45:55 AM Mountain Daylight Time	07/08/2014 01:24:58 PM Mountain Daylight Time				07/22/2014 12:45:49 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue (HMO)	01	01		1			H1350	006	0	2015	Select Counties in Idaho		2	3340	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673										(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363										2					2					2
H1350	009	0	1	01	01	H1350_009_0	5	2	1	07/22/2014	2015.01	07/22/2014 12:23:29 PM Mountain Daylight Time	08/04/2014 11:34:14 AM Mountain Daylight Time	08/04/2014 11:34:15 AM Mountain Daylight Time			08/04/2014 02:20:07 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Special Needs Plan (HMO SNP)	01	01		1			H1350	009	0	2015	Select Counties in Idaho		2	716	2			1	3		1	5			www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2
H1350	010	0	1	01	01	H1350_010_0	4		1	08/01/2014	2015.01	08/01/2014 11:40:07 AM Mountain Daylight Time	08/04/2014 11:34:16 AM Mountain Daylight Time	08/04/2014 11:34:17 AM Mountain Daylight Time			08/04/2014 02:20:07 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Rx Option II (HMO)	01	01		1			H1350	010	0	2015	Select Counties in Idaho		2	3525	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2
H1350	012	0	1	01	01	H1350_012_0	4		1	08/01/2014	2015.01	08/01/2014 11:40:59 AM Mountain Daylight Time	08/04/2014 11:34:18 AM Mountain Daylight Time	08/04/2014 11:34:19 AM Mountain Daylight Time			08/04/2014 02:20:07 PM Mountain Daylight Time	BLUE CROSS OF IDAHO HEALTH SERVICE, INC.	Blue Cross of Idaho	www.bcidaho.com/medicare	True Blue Connected Care (HMO)	01	01		1			H1350	012	0	2015	Ada, Canyon, Gem, Payette		2	1355	2			2							www.bcidaho.com/medicare/MA-providers	www.bcidaho.com/medicare/MA-formulary	www.bcidaho.com/medicare	(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(888)494-2583		(208)395-8200		(888)492-2583		(208)387-6673		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		(800)377-1363		2					2					2
H1357	001	0	1	20	08	H1357_001_0	1		1	05/20/2014	2015.01	05/20/2014 02:26:02 PM Eastern Daylight Time		05/17/2014 02:19:19 PM Eastern Daylight Time			05/20/2014 02:28:26 PM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	http://www.carolinaseniorcare.org/	Carolina SeniorCare (PACE)	08	20		1			H1357	001	0	2015	Carolina SeniorCare		2		2			2								www.uchas.org	www.uchas.org									(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500										(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500												
H1357	002	0	1	20	08	H1357_002_0	1		1	05/20/2014	2015.01	05/20/2014 02:26:30 PM Eastern Daylight Time		05/17/2014 02:19:02 PM Eastern Daylight Time			05/20/2014 02:28:26 PM Eastern Daylight Time	CAROLINA SENIORCARE	Carolina SeniorCare	www.uchas.org	Carolina SeniorCare (PACE)	08	20		1			H1357	002	0	2015	Carolina SeniorCare		2		2			2								www.uchas.org	www.uchas.org									(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500										(888)351-7227		(336)746-3500		(888)351-7227		(336)746-3500												
H1365	001	0	1	04	01	H1365_001_0	7		1	08/06/2014	2015.02	08/06/2014 06:40:40 PM Eastern Daylight Time	08/05/2014 08:42:12 PM Eastern Daylight Time	08/05/2014 08:42:30 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	001	0	2015	Counties: Andr,Cumb,Frk,Knx,Linc,Oxf, Sag,Wald,Yrk		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1365	002	0	1	04	01	H1365_002_0	7		1	08/06/2014	2015.02	08/06/2014 06:41:00 PM Eastern Daylight Time	08/05/2014 08:42:55 PM Eastern Daylight Time	08/05/2014 08:42:57 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	002	0	2015	Counties: Aroos, Hanc,Kenn,Penob,Pisc, Som,Wash		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1365	003	0	1	04	01	H1365_003_0	7		1	08/06/2014	2015.02	08/06/2014 06:41:19 PM Eastern Daylight Time	08/06/2014 05:43:48 PM Eastern Daylight Time	08/05/2014 08:43:29 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Select (PPO)	01	04		1			H1365	003	0	2015	Hillsborough, Strafford, NH		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1365	802	0	1	04	01	H1365_802_0	4		1	06/02/2014	2015.02	06/02/2014 08:19:15 AM Eastern Daylight Time	06/02/2014 05:04:14 PM Eastern Daylight Time				06/04/2014 01:33:51 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	802	0	2015	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(888)423-9320		(888)423-9320		(888)640-4423		(888)640-4423		(888)423-9320		(888)423-9320		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011100110110110011100000100	1	100000011010000000000000000	1					
H1365	803	0	1	04	01	H1365_803_0	4		1	06/02/2014	2015.02	06/02/2014 08:19:23 AM Eastern Daylight Time	06/02/2014 05:11:14 PM Eastern Daylight Time				06/04/2014 01:33:51 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Premier Group (PPO)	01	04		1			H1365	803	0	2015	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100110100111011100000100	1	100000000010000000000000000	1					
H1406	013	0	1	01	01	H1406_013_0	4		1	08/02/2014	2015.02	08/02/2014 11:10:42 AM Eastern Daylight Time	08/04/2014 09:09:54 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-013 (HMO)	01	01		1			H1406	013	0	2015	Cook, Lake and Will counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	022	0	1	01	01	H1406_022_0	4		1	07/10/2014	2015.02	07/10/2014 12:37:21 PM Eastern Daylight Time	08/04/2014 10:19:39 PM Eastern Daylight Time	08/04/2014 05:04:08 PM Eastern Daylight Time			08/06/2014 08:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-022 (HMO)	01	01		1			H1406	022	0	2015	Kane, Kendall and McHenry counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	026	0	1	01	01	H1406_026_0	4		1	07/10/2014	2015.02	07/10/2014 12:41:50 PM Eastern Daylight Time	08/05/2014 08:36:29 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-026 (HMO)	01	01		1			H1406	026	0	2015	Rockford Illinois area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	028	0	1	01	01	H1406_028_0	4		1	08/02/2014	2015.02	08/02/2014 11:14:42 AM Eastern Daylight Time	08/04/2014 10:26:23 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-028 (HMO)	01	01		1			H1406	028	0	2015	DuPage County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	029	0	1	01	01	H1406_029_0	4		1	08/04/2014	2015.02	08/04/2014 11:36:45 AM Eastern Daylight Time	08/04/2014 10:25:12 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H1406-029 (HMO SNP)	01	01		1			H1406	029	0	2015	DuPage County		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	030	0	1	01	01	H1406_030_0	5		1	07/10/2014	2015.02	07/10/2014 05:13:26 PM Eastern Daylight Time	08/04/2014 10:24:00 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H1406-030 (HMO)	01	01		1			H1406	030	0	2015	Logan and Sangamon counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	031	0	1	01	01	H1406_031_0	5	2	1	08/02/2014	2015.02	08/02/2014 11:21:33 AM Eastern Daylight Time	08/04/2014 10:32:01 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1406-031 (HMO SNP)	01	01		1			H1406	031	0	2015	Rockford Illinois area		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1406	801	0	1	01	01	H1406_801_0	3		1	05/23/2014	2015.02	05/23/2014 02:29:29 PM Eastern Daylight Time	07/14/2014 10:45:27 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1406	801	0	2015	Select counties in Chicago Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1406	802	0	1	01	01	H1406_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:30:23 PM Eastern Daylight Time	07/14/2014 10:51:27 AM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1406	802	0	2015	Select counties in Chicago Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1415	005	0	1	01	01	H1415_005_0	3	2	1	05/21/2014	2015.02	05/21/2014 05:18:43 PM Central Daylight Time	08/04/2014 10:33:50 AM Central Daylight Time	07/31/2014 03:50:32 PM Central Daylight Time			08/05/2014 09:57:48 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H1415	005	0	2015	Cook, DuPage, Kane,  and Will		2		2			1	3		1	2				www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1415	013	0	1	01	01	H1415_013_0	2		1	07/16/2014	2015.02	07/16/2014 02:14:30 PM Central Daylight Time	05/29/2014 09:46:03 AM Central Daylight Time				07/17/2014 11:44:18 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H1415	013	0	2015	Cook, DuPage, Kane, and Will		2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										2					2					2
H1415	021	0	1	02	01	H1415_021_0	5		1	07/16/2014	2015.02	07/16/2014 02:15:45 PM Central Daylight Time	08/04/2014 10:34:00 AM Central Daylight Time	07/31/2014 03:50:42 PM Central Daylight Time			08/05/2014 09:57:48 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H1415	021	0	2015	Cook, DuPage, Kane, and Will		2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1415	024	0	1	01	01	H1415_024_0	4		1	07/16/2014	2015.02	07/16/2014 02:16:10 PM Central Daylight Time	08/04/2014 10:34:12 AM Central Daylight Time	07/31/2014 03:50:52 PM Central Daylight Time			08/05/2014 09:57:48 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H1415	024	0	2015	Cook, DuPage, Kane, and Will		2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1416	007	0	1	01	01	H1416_007_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:32:41 AM Eastern Daylight Time	08/05/2014 11:25:29 AM Eastern Daylight Time	08/01/2014 11:30:12 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1416	007	0	2015	Chicago, St. Louis, Peoria, Champaign, Kankakee		2	4784	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)439-1190		(866)439-1190		(877)817-5794		(877)817-5794		(866)439-1190		(866)439-1190		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1416	009	0	1	02	01	H1416_009_0	7		1	08/04/2014	2015.02	08/04/2014 01:22:59 PM Eastern Daylight Time	08/05/2014 11:25:43 AM Eastern Daylight Time	08/01/2014 11:30:23 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com	WellCare Value (HMO-POS)	01	02		1			H1416	009	0	2015	Chicago, St. Louis, Peoria, Champaign, Kankakee		2	26163	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)334-6876		(866)334-6876		(877)817-5794		(877)817-5794		(866)334-6876		(866)334-6876		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1416	023	0	1	01	01	H1416_023_0	7		1	07/24/2014	2015.02	07/24/2014 07:33:03 AM Eastern Daylight Time	08/05/2014 11:25:57 AM Eastern Daylight Time	08/01/2014 11:30:33 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	HARMONY HEALTH PLAN OF ILLINOIS, INC.	WellCare	www.wellcare.com	WellCare Rx (HMO)	01	01		1			H1416	023	0	2015	Chicago, St. Louis, Peoria, Champaign, Kankakee		2	483	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)334-6876		(866)334-6876		(877)817-5794		(877)817-5794		(866)334-6876		(866)334-6876		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1417	001	0	1	04	01	H1417_001_0	2		1	07/14/2014	2015.01	07/14/2014 12:36:47 PM Central Daylight Time	05/31/2014 08:56:50 PM Central Daylight Time				07/14/2014 12:46:40 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO10 (PPO)	01	04		1			H1417	001	0	2015	Central Illinois		2	329	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					
H1417	002	0	1	04	01	H1417_002_0	3		1	08/06/2014	2015.01	08/06/2014 09:08:25 AM Central Daylight Time	08/05/2014 06:07:44 PM Central Daylight Time	07/31/2014 04:49:56 PM Central Daylight Time			08/06/2014 01:16:42 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO10 Rx (PPO)	01	04		1			H1417	002	0	2015	Central Illinois		2	4113	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					
H1417	003	0	1	04	01	H1417_003_0	2		1	07/14/2014	2015.01	07/14/2014 12:37:01 PM Central Daylight Time	05/31/2014 08:58:25 PM Central Daylight Time				07/14/2014 12:46:40 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO30 (PPO)	01	04		1			H1417	003	0	2015	Central Illinois		2	196	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					
H1417	004	0	1	04	01	H1417_004_0	3		1	08/05/2014	2015.01	08/05/2014 09:23:44 AM Central Daylight Time	08/05/2014 06:08:27 PM Central Daylight Time	07/31/2014 04:50:00 PM Central Daylight Time			08/06/2014 01:16:42 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO30 Rx (PPO)	01	04		1			H1417	004	0	2015	Central Illinois		2	2359	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					
H1417	010	0	1	04	01	H1417_010_0	3		1	08/05/2014	2015.01	08/05/2014 09:23:56 AM Central Daylight Time	08/05/2014 06:09:18 PM Central Daylight Time	07/31/2014 04:50:04 PM Central Daylight Time			08/06/2014 01:16:42 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO Basic Rx (PPO)	01	04		1			H1417	010	0	2015	Central Illinois		2	1028	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					
H1417	011	0	1	04	01	H1417_011_0	2		1	07/14/2014	2015.01	07/14/2014 12:37:23 PM Central Daylight Time	05/31/2014 09:01:18 PM Central Daylight Time				07/14/2014 12:46:40 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare PPO Basic (PPO)	01	04		1			H1417	011	0	2015	Central Illinois		2	90	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					
H1417	801	0	1	04	01	H1417_801_0	1		1	05/28/2014	2015.01	05/28/2014 04:12:52 PM Central Daylight Time	05/31/2014 09:02:46 PM Central Daylight Time				06/01/2014 07:28:25 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer PPO (PPO)	01	04		1			H1417	801	0	2015	Illinois		1	6	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										1	2		2		1					
H1417	802	0	1	04	01	H1417_802_0	1		1	05/28/2014	2015.01	05/28/2014 04:13:00 PM Central Daylight Time	05/31/2014 09:03:54 PM Central Daylight Time				06/01/2014 07:28:25 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer PPO Rx (PPO)	01	04		1			H1417	802	0	2015	Illinois		1	622	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1					
H1417	810	0	1	04	01	H1417_810_0	1		1	05/28/2014	2015.01	05/28/2014 04:13:05 PM Central Daylight Time	05/31/2014 09:05:34 PM Central Daylight Time				06/01/2014 07:28:25 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer PPO Rx (PPO) - non calendar year (PPO)	01	04		1			H1417	810	0	2015	Illinois		1	4	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1					
H1418	002	0	1	04	01	H1418_002_0	4		1	07/10/2014	2015.02	07/10/2014 01:00:09 PM Eastern Daylight Time	08/04/2014 09:11:43 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1418-002 (PPO)	01	04		1			H1418	002	0	2015	Chicago Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1418	007	0	1	04	01	H1418_007_0	4		1	07/10/2014	2015.02	07/10/2014 01:05:57 PM Eastern Daylight Time	08/04/2014 09:54:37 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1418-007 (PPO)	01	04		1			H1418	007	0	2015	Central Illinois area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1418	008	0	1	04	01	H1418_008_0	3		1	07/10/2014	2015.02	07/10/2014 12:46:10 PM Eastern Daylight Time	08/02/2014 11:35:58 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1418-008 (PPO)	01	04		1			H1418	008	0	2015	Scott County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1419	001	0	1	01	01	H1419_001_0	5		1	08/03/2014	2015.01	08/03/2014 05:04:29 PM Eastern Daylight Time	08/05/2014 11:46:56 AM Eastern Daylight Time	07/31/2014 05:23:15 PM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H1419	001	0	2015	Cook County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1419	801	0	1	01	01	H1419_801_0	2		1	05/20/2014	2015.01	05/20/2014 09:28:27 AM Eastern Daylight Time	06/21/2014 10:14:53 PM Eastern Daylight Time				07/21/2014 10:21:55 AM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H1419	801	0	2015	Illinois		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H1419	802	0	1	01	01	H1419_802_0	3		1	05/20/2014	2015.01	05/20/2014 09:33:47 AM Eastern Daylight Time	06/21/2014 10:52:35 PM Eastern Daylight Time				07/21/2014 10:21:55 AM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H1419	802	0	2015	Illinois		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H1419	804	0	1	01	01	H1419_804_0	3		1	05/29/2014	2015.01	05/29/2014 09:14:14 AM Eastern Daylight Time	06/21/2014 10:54:32 PM Eastern Daylight Time				07/21/2014 10:21:55 AM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan with NCY Rx (HMO)	01	01		1			H1419	804	0	2015	Illinois		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H1444	001	0	1	01	01	H1444_001_0	8	2	1	08/06/2014	2015.01	08/06/2014 06:19:15 AM Eastern Daylight Time	08/01/2014 01:15:37 PM Eastern Daylight Time	08/01/2014 12:53:35 PM Eastern Daylight Time			08/06/2014 06:25:58 AM Eastern Daylight Time	TOTAL HEALTH CARE, INC.	Total Medicare Plus	www.TotalMedicarePlus.com	Total Medicare Plus (HMO SNP)	01	01		1			H1444	001	0	2015	Wayne County		2	167	2			1	3		1	3		1	www.TotalMedicarePlus.com	www.TotalMedicarePlus.com	www.TotalMedicarePlus.com	(855)377-2417		(855)377-2417		(855)377-2417		(855)377-2417		(855)348-3231		(855)348-3231		(855)348-3231		(855)348-3231		(800)649-3777		(711)-		(800)649-3777		(711)-		(800)649-3777		(711)-		(800)649-3777		(711)-		2					2					2
H1463	001	0	1	01	01	H1463_001_0	2		1	07/08/2014	2015.01	07/08/2014 10:26:28 AM Central Daylight Time	05/31/2014 09:07:24 PM Central Daylight Time				07/08/2014 10:30:20 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO20 (HMO)	01	01		1			H1463	001	0	2015	East Central Illinois		2	1079	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					2
H1463	003	0	1	01	01	H1463_003_0	3		1	08/05/2014	2015.01	08/05/2014 09:24:08 AM Central Daylight Time	08/05/2014 06:10:29 PM Central Daylight Time	07/31/2014 04:50:08 PM Central Daylight Time			08/06/2014 01:21:23 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO20 Rx (HMO)	01	01		1			H1463	003	0	2015	East Central Illinois		2	4069	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2
H1463	008	0	1	01	01	H1463_008_0	2		1	07/08/2014	2015.01	07/08/2014 10:26:05 AM Central Daylight Time	05/31/2014 09:11:59 PM Central Daylight Time				07/08/2014 10:30:20 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic (HMO)	01	01		1			H1463	008	0	2015	East Central Illinois		2	79	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					2
H1463	009	0	1	01	01	H1463_009_0	3		1	08/05/2014	2015.01	08/05/2014 09:24:18 AM Central Daylight Time	08/05/2014 06:11:19 PM Central Daylight Time	07/31/2014 04:50:12 PM Central Daylight Time			08/06/2014 01:21:23 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO Basic Rx (HMO)	01	01		1			H1463	009	0	2015	East Central Illinois		2	441	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2
H1463	010	0	1	01	01	H1463_010_0	3		1	08/05/2014	2015.01	08/05/2014 09:24:26 AM Central Daylight Time	08/05/2014 06:12:05 PM Central Daylight Time	07/31/2014 04:50:16 PM Central Daylight Time			08/06/2014 01:21:23 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Heatlh Alliance Medicare HMO 40 Rx (HMO)	01	01		1			H1463	010	0	2015	East Central Illinois		2	1017	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					2					2
H1463	011	0	1	01	01	H1463_011_0	2		1	07/08/2014	2015.01	07/08/2014 10:25:28 AM Central Daylight Time	05/31/2014 09:13:51 PM Central Daylight Time				07/08/2014 10:30:20 AM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Health Alliance Medicare HMO 40 (HMO)	01	01		1			H1463	011	0	2015	East Central Illinois		2	90	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										2					2					2
H1463	801	0	1	01	01	H1463_801_0	1		1	05/28/2014	2015.01	05/28/2014 04:10:54 PM Central Daylight Time	05/31/2014 09:14:48 PM Central Daylight Time				06/01/2014 06:50:07 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1463	801	0	2015	Illinois		1	7	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844										1	2		2		1					1
H1463	802	0	1	01	01	H1463_802_0	1		1	05/28/2014	2015.01	05/28/2014 04:11:12 PM Central Daylight Time	05/31/2014 09:15:48 PM Central Daylight Time				06/01/2014 06:50:07 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1463	802	0	2015	Illinois		1	176	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1					1
H1463	810	0	1	01	01	H1463_810_0	1		1	05/28/2014	2015.01	05/28/2014 04:11:20 PM Central Daylight Time	05/31/2014 09:17:32 PM Central Daylight Time				06/01/2014 06:50:07 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medical Plans	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	01	01		1			H1463	810	0	2015	Illinois		1	3	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)965-4022		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		1	2		2		1					1
H1468	007	0	1	01	01	H1468_007_0	4		1	07/10/2014	2015.02	07/10/2014 01:13:14 PM Eastern Daylight Time	08/04/2014 09:59:16 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Gold Plus H1468-007 (HMO)	01	01		1			H1468	007	0	2015	Peoria Illinois Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1468	802	0	1	01	01	H1468_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:31:18 PM Eastern Daylight Time	07/14/2014 10:58:45 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1468	802	0	2015	Select counties in Peoria Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1468	803	0	1	01	01	H1468_803_0	2		1	05/23/2014	2015.02	05/23/2014 02:32:02 PM Eastern Daylight Time	07/14/2014 10:59:35 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1468	803	0	2015	Select counties in Peoria Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1500	001	0	1	20	08	H1500_001_0	1		1	05/29/2014	2015.01	05/29/2014 02:22:44 PM Eastern Daylight Time		05/29/2014 02:30:39 PM Eastern Daylight Time			05/29/2014 02:32:10 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	www.sjp.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	001	0	2015	LIFE St. Joseph of the Pines		2		2			2								www.sjp.org	www.sjp.org									(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204										(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204												
H1500	002	0	1	20	08	H1500_002_0	1		1	05/29/2014	2015.01	05/29/2014 02:19:58 PM Eastern Daylight Time		05/29/2014 02:30:20 PM Eastern Daylight Time			05/29/2014 02:32:10 PM Eastern Daylight Time	LIFE ST. JOSEPH OF THE PINES, INC.	LIFE St. Joseph of the Pines	www.sjp.org	LIFE St. Joseph of the Pines (PACE)	08	20		1			H1500	002	0	2015	LIFE St. Joseph of the Pines		2		2			2								www.sjp.org	www.sjp.org									(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204										(800)246-1000		(910)429-7204		(800)246-1000		(910)429-7204												
H1509	001	0	1	04	01	H1509_001_0	2		1	07/16/2014	2015.02	07/16/2014 04:25:35 PM Central Daylight Time	08/04/2014 02:39:04 PM Central Daylight Time	08/01/2014 02:27:16 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1509	001	0	2015	Northern Indiana		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1509	009	0	1	04	01	H1509_009_0	2		1	05/30/2014	2015.02	05/30/2014 11:02:26 AM Central Daylight Time	08/04/2014 02:39:29 PM Central Daylight Time	07/31/2014 03:18:23 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1509	009	0	2015	Evansville area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1509	010	0	1	04	01	H1509_010_0	2		1	05/20/2014	2015.02	05/20/2014 12:10:35 PM Central Daylight Time	08/04/2014 02:39:54 PM Central Daylight Time	07/31/2014 03:18:28 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H1509	010	0	2015	Indianapolis area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1509	011	0	1	04	01	H1509_011_0	2		1	05/19/2014	2015.02	05/19/2014 05:24:57 PM Central Daylight Time	08/04/2014 02:40:18 PM Central Daylight Time	07/31/2014 03:18:32 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (PPO)	01	04		1			H1509	011	0	2015	Fort Wayne area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1509	801	0	1	04	01	H1509_801_0	1		1	05/23/2014	2015.01	05/23/2014 09:24:50 AM Central Daylight Time	05/30/2014 05:48:52 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	801	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	803	0	1	04	01	H1509_803_0	1		1	05/23/2014	2015.01	05/23/2014 09:26:03 AM Central Daylight Time	05/30/2014 05:49:23 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	803	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1509	804	0	1	04	01	H1509_804_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:35 AM Central Daylight Time	05/30/2014 05:49:52 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	804	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	806	0	2	04	01	H1509_806_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:35 AM Central Daylight Time	05/30/2014 05:50:23 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1509	806	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	807	0	2	04	01	H1509_807_0	1		1	05/23/2014	2015.01	05/23/2014 09:26:07 AM Central Daylight Time	05/30/2014 05:50:53 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1509	807	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1509	808	0	2	04	01	H1509_808_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:36 AM Central Daylight Time	05/30/2014 05:51:23 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1509	808	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	809	0	1	04	01	H1509_809_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:37 AM Central Daylight Time	05/30/2014 05:51:49 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	809	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	810	0	1	04	01	H1509_810_0	1		1	05/23/2014	2015.01	05/23/2014 09:26:11 AM Central Daylight Time	05/30/2014 05:52:15 PM Central Daylight Time				05/31/2014 12:47:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	810	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1509	811	0	1	04	01	H1509_811_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:38 AM Central Daylight Time	05/30/2014 05:52:42 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	811	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	812	0	1	04	01	H1509_812_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:38 AM Central Daylight Time	05/30/2014 05:53:06 PM Central Daylight Time				05/31/2014 12:47:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	812	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	813	0	1	04	01	H1509_813_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:39 AM Central Daylight Time	05/30/2014 05:53:30 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	813	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	819	0	1	04	01	H1509_819_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:39 AM Central Daylight Time	05/30/2014 05:54:00 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	819	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	821	0	1	04	01	H1509_821_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:40 AM Central Daylight Time	05/30/2014 05:54:30 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	821	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	822	0	1	04	01	H1509_822_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:40 AM Central Daylight Time	05/30/2014 05:54:59 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	822	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	823	0	1	04	01	H1509_823_0	1		1	05/23/2014	2015.01	05/23/2014 09:26:15 AM Central Daylight Time	05/30/2014 05:55:29 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	823	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1509	824	0	1	04	01	H1509_824_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:41 AM Central Daylight Time	05/30/2014 05:55:59 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1509	824	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	825	0	2	04	01	H1509_825_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:42 AM Central Daylight Time	05/30/2014 05:56:29 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1509	825	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1509	826	0	2	04	01	H1509_826_0	1		1	05/23/2014	2015.01	05/23/2014 09:26:29 AM Central Daylight Time	05/30/2014 05:56:59 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1509	826	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1509	827	0	2	04	01	H1509_827_0	1		1	05/23/2014	2015.01	05/23/2014 09:25:43 AM Central Daylight Time	05/30/2014 05:57:29 PM Central Daylight Time				05/31/2014 11:51:37 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1509	827	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1510	001	0	1	04	01	H1510_001_0	3		1	08/02/2014	2015.02	08/02/2014 10:40:44 AM Eastern Daylight Time	08/05/2014 09:40:36 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-001 (PPO)	01	04		1			H1510	001	0	2015	Central Indiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1510	004	0	1	04	01	H1510_004_0	3		1	07/10/2014	2015.02	07/10/2014 01:08:09 PM Eastern Daylight Time	08/05/2014 09:37:38 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-004 (PPO)	01	04		1			H1510	004	0	2015	Evansville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1510	005	0	1	04	01	H1510_005_0	3		1	07/10/2014	2015.02	07/10/2014 01:10:03 PM Eastern Daylight Time	08/05/2014 09:38:00 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-005 (PPO)	01	04		1			H1510	005	0	2015	Northern Indiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1510	008	0	1	04	01	H1510_008_0	3		1	07/10/2014	2015.02	07/10/2014 01:11:59 PM Eastern Daylight Time	08/05/2014 09:51:57 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1510-008 (PPO)	01	04		1			H1510	008	0	2015	Southern Indiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1517	006	1	1	04	01	H1517_006_1	15		1	07/16/2014	2015.01	07/16/2014 04:46:57 PM Eastern Daylight Time	08/06/2014 01:25:26 PM Eastern Daylight Time	08/06/2014 01:28:38 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Core (PPO)	01	04		1			H1517	006	1	2015	St.Louis Springfield Joplin	St. louis	2	1279	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-6427		(800)797-6427		(800)467-1199		(800)467-1199		(800)467-1199		(800)467-1199		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1517	006	2	1	04	01	H1517_006_2	15		1	07/16/2014	2015.01	07/16/2014 04:47:16 PM Eastern Daylight Time	08/06/2014 01:25:11 PM Eastern Daylight Time	08/06/2014 01:28:49 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Core (PPO)	01	04		1			H1517	006	2	2015	St.Louis Springfield Joplin	Springfield	2	1412	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-6427		(800)797-6427		(800)467-1199		(800)467-1199		(800)467-1199		(800)467-1199		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1517	006	4	1	04	01	H1517_006_4	15		1	07/16/2014	2015.01	07/16/2014 04:47:49 PM Eastern Daylight Time	08/06/2014 01:25:39 PM Eastern Daylight Time	08/06/2014 01:29:00 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Core (PPO)	01	04		1			H1517	006	4	2015	St.Louis Springfield Joplin	Joplin	2	376	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-6427		(800)797-6427		(800)467-1199		(800)467-1199		(800)467-1199		(800)467-1199		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1517	801	0	1	04	01	H1517_801_0	7		1	05/30/2014	2015.01	05/30/2014 03:06:47 PM Pacific Daylight Time	07/15/2014 03:51:13 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1517	801	0	2015	Missouri		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H1517	802	0	1	04	01	H1517_802_0	6		1	05/30/2014	2015.01	05/30/2014 03:08:44 PM Pacific Daylight Time	07/15/2014 03:51:23 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1517	802	0	2015	Missouri		1	148	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H1517	803	0	1	04	01	H1517_803_0	6		1	05/30/2014	2015.01	05/30/2014 03:07:38 PM Pacific Daylight Time	07/15/2014 03:51:32 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1517	803	0	2015	Missouri		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H1518	001	0	1	20	08	H1518_001_0	1		1	05/21/2014	2015.01	05/21/2014 01:07:50 PM Eastern Daylight Time		05/20/2014 04:56:20 PM Eastern Daylight Time			05/21/2014 01:14:13 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	www.chsbuffalo.org/services/seniorservices/LIFE	CHS Buffalo - Dual (PACE)	08	20		1			H1518	001	0	2015	CHS Lackawanna  Erie County		2		2			2								www.chsbuffalo.org	www.chsbuffalo.org									(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061										(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061												
H1518	002	0	1	20	08	H1518_002_0	1		1	05/21/2014	2015.01	05/21/2014 01:10:35 PM Eastern Daylight Time		05/20/2014 04:56:30 PM Eastern Daylight Time			05/21/2014 01:14:13 PM Eastern Daylight Time	CATHOLIC HEALTH SYSTEM BUFFALO PACE	Catholic Health LIFE	www.chsbuffalo.org/Services/SeniorServices/LIFE	CHS Buffalo - Medicare only (PACE)	08	20		1			H1518	002	0	2015	CHS Lackawanna Erie County		2		2			2								www.chsbuffalo.org	www.chsbuffalo.org									(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061										(888)845-0247		(716)819-5433		(888)845-0247		(716)819-5061												
H1533	001	0	1	20	08	H1533_001_0	1		1	05/23/2014	2015.01	05/23/2014 01:53:04 PM Eastern Daylight Time		05/17/2014 03:06:40 PM Eastern Daylight Time			05/23/2014 01:54:04 PM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	www.staywellseniorcare.org	StayWell Senior Care - Dual Eligible (PACE)	08	20		1			H1533	001	0	2015	StayWell Senior Care		2		2			2								www.staywellseniorcare.org	www.carekinesis.com									(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200										(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200												
H1533	002	0	1	20	08	H1533_002_0	1		1	05/23/2014	2015.01	05/23/2014 12:55:19 PM Eastern Daylight Time		05/17/2014 03:12:32 PM Eastern Daylight Time			05/23/2014 01:54:04 PM Eastern Daylight Time	STAYWELL SENIOR CARE, INC.	StayWell Senior Care	www.staywellseniorcare.org	StayWell Senior Care - Medicare Only (PACE)	08	20		1			H1533	002	0	2015	StayWell Senior Care		2		2			2								www.staywellseniorcare.org	www.carekinesis.com									(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200										(336)628-4200		(336)628-4200		(336)628-4200		(336)628-4200												
H1537	001	0	1	04	01	H1537_001_0	2		1	05/30/2014	2015.01	05/30/2014 04:28:27 PM Central Daylight Time	08/04/2014 02:43:20 PM Central Daylight Time	07/31/2014 03:18:37 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (PPO)	01	04		1			H1537	001	0	2015	Madison county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1537	801	0	1	04	01	H1537_801_0	1		1	04/30/2014	2015.01	04/30/2014 03:13:02 PM Central Daylight Time	05/30/2014 05:58:38 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	801	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	802	0	1	04	01	H1537_802_0	1		1	04/16/2014	2015.01	04/16/2014 04:05:28 PM Central Daylight Time	05/30/2014 05:59:04 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	802	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1537	803	0	1	04	01	H1537_803_0	1		1	04/16/2014	2015.01	04/16/2014 04:06:03 PM Central Daylight Time	05/30/2014 05:59:31 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	803	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	804	0	2	04	01	H1537_804_0	1		1	04/16/2014	2015.01	04/16/2014 04:06:31 PM Central Daylight Time	05/30/2014 05:59:58 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	804	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	805	0	2	04	01	H1537_805_0	1		1	04/16/2014	2015.01	04/16/2014 04:07:05 PM Central Daylight Time	05/30/2014 06:00:28 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	805	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1537	806	0	2	04	01	H1537_806_0	1		1	04/16/2014	2015.01	04/16/2014 04:07:55 PM Central Daylight Time	05/30/2014 06:00:55 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	806	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	807	0	1	04	01	H1537_807_0	1		1	04/16/2014	2015.01	04/16/2014 04:08:52 PM Central Daylight Time	05/30/2014 06:01:19 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	807	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	808	0	1	04	01	H1537_808_0	1		1	04/16/2014	2015.01	04/16/2014 04:09:17 PM Central Daylight Time	05/30/2014 06:01:43 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	808	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1537	809	0	1	04	01	H1537_809_0	1		1	04/16/2014	2015.01	04/16/2014 04:09:42 PM Central Daylight Time	05/30/2014 06:02:05 PM Central Daylight Time				05/31/2014 12:47:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	809	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	816	0	1	04	01	H1537_816_0	2		1	04/16/2014	2015.01	04/16/2014 04:10:11 PM Central Daylight Time	05/30/2014 06:02:26 PM Central Daylight Time				05/31/2014 12:47:13 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	816	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	817	0	1	04	01	H1537_817_0	1		1	04/16/2014	2015.01	04/16/2014 04:10:43 PM Central Daylight Time	05/30/2014 06:02:48 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	817	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	823	0	1	04	01	H1537_823_0	1		1	04/16/2014	2015.01	05/07/2014 03:36:50 PM Central Daylight Time	05/30/2014 06:03:14 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	823	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	824	0	1	04	01	H1537_824_0	1		1	04/16/2014	2015.01	05/07/2014 03:36:51 PM Central Daylight Time	05/30/2014 06:03:41 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	824	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	825	0	1	04	01	H1537_825_0	1		1	05/07/2014	2015.01	05/07/2014 03:37:01 PM Central Daylight Time	05/30/2014 06:04:07 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	825	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1537	826	0	1	04	01	H1537_826_0	1		1	04/16/2014	2015.01	05/07/2014 03:36:52 PM Central Daylight Time	05/30/2014 06:04:34 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H1537	826	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	827	0	2	04	01	H1537_827_0	1		1	04/16/2014	2015.01	05/07/2014 03:36:52 PM Central Daylight Time	05/30/2014 06:05:02 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	827	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1537	828	0	2	04	01	H1537_828_0	1		1	05/07/2014	2015.01	05/07/2014 03:37:04 PM Central Daylight Time	05/30/2014 06:05:28 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	828	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H1537	829	0	2	04	01	H1537_829_0	1		1	04/16/2014	2015.01	05/07/2014 03:36:53 PM Central Daylight Time	05/30/2014 06:05:56 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H1537	829	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1587	001	0	1	01	01	H1587_001_0	4	2	1	08/04/2014	2015.01	08/04/2014 07:40:14 AM Central Daylight Time	08/05/2014 10:44:00 AM Central Daylight Time	08/05/2014 10:44:00 AM Central Daylight Time			08/05/2014 11:21:03 AM Central Daylight Time	ARKANSAS SUPERIOR SELECT, INC.	Tribute Health Plan of Arkansas	www.tributehealthplans.com	Tribute Health Plan of Arkansas (HMO SNP)	01	01		1			H1587	001	0	2015	Northern Arkansas		2		2			1	3		1	3		1	www.tributehealthplans.com	www.tributehealthplans.com	www.tributehealthplans.com	(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		(844)813-4404		(501)372-1922		2					2					2
H1595	003	0	1	04	01	H1595_003_0	6		1	07/18/2014	2015.01	07/18/2014 11:42:15 AM Eastern Daylight Time	08/06/2014 08:16:42 AM Eastern Daylight Time	08/06/2014 08:16:43 AM Eastern Daylight Time			08/06/2014 09:25:29 AM Eastern Daylight Time	HEALTHPLUS INSURANCE COMPANY	HealthPlus	www.healthplus.org	HealthPlus MedicarePlus Classic (PPO)	01	04		1			H1595	003	0	2015	22 Mid-Michigan and Southeast Michigan Counties		2	303	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					
H1595	004	0	1	04	01	H1595_004_0	6		1	07/18/2014	2015.01	07/18/2014 11:42:22 AM Eastern Daylight Time	08/06/2014 08:16:43 AM Eastern Daylight Time	08/06/2014 08:16:43 AM Eastern Daylight Time			08/06/2014 09:25:29 AM Eastern Daylight Time	HEALTHPLUS INSURANCE COMPANY	HealthPlus	www.healthplus.org	HealthPlus MedicarePlus Essential (PPO)	01	04		1			H1595	004	0	2015	22 Mid and Southeastern Michigan Counties		2		2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					
H1595	801	0	1	04	01	H1595_801_0	4		1	07/02/2014	2015.01	07/02/2014 02:52:00 PM Eastern Daylight Time	07/21/2014 09:57:32 AM Eastern Daylight Time				07/21/2014 10:04:37 AM Eastern Daylight Time	HEALTHPLUS INSURANCE COMPANY	HealthPlus	www.healthplus.org	Emp-only - HealthPlus MA-Only (PPO)	01	04		1			H1595	801	0	2015	United States EG Area		1	100	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161										(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070										1	2		2		1					
H1595	802	0	1	04	01	H1595_802_0	5		1	07/15/2014	2015.01	07/15/2014 01:48:47 PM Eastern Daylight Time	07/21/2014 09:57:32 AM Eastern Daylight Time				07/21/2014 10:04:37 AM Eastern Daylight Time	HEALTHPLUS INSURANCE COMPANY	HealthPlus	www.healthplus.org	Emp-only - HealthPlus MA-PD calendar yr. (PPO)	01	04		1			H1595	802	0	2015	United States EG Area		1	961	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					
H1595	804	0	1	04	01	H1595_804_0	5		1	07/15/2014	2015.01	07/15/2014 01:49:01 PM Eastern Daylight Time	07/21/2014 09:57:32 AM Eastern Daylight Time				07/21/2014 10:04:37 AM Eastern Daylight Time	HEALTHPLUS INSURANCE COMPANY	HealthPlus	www.healthplus.org	Emp-only - HealthPlus MA-PD non-calendar yr. (PPO)	01	04		1			H1595	804	0	2015	United States EG Area		1	414	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					
H1607	012	0	1	04	01	H1607_012_0	15		1	07/16/2014	2015.01	07/16/2014 04:44:37 PM Eastern Daylight Time	08/06/2014 01:26:05 PM Eastern Daylight Time	08/06/2014 01:29:28 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H1607	012	0	2015	Select Counties in Indiana		2	2284	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-6421		(800)797-6421		(800)467-1199		(800)467-1199		(800)797-6421		(800)797-6421		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1607	804	0	1	04	01	H1607_804_0	6		1	05/30/2014	2015.01	05/30/2014 03:08:58 PM Pacific Daylight Time	07/15/2014 03:56:37 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	804	0	2015	Indiana		1	6741	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H1607	805	0	1	04	01	H1607_805_0	6		1	05/30/2014	2015.01	05/30/2014 03:09:03 PM Pacific Daylight Time	07/15/2014 03:48:55 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	805	0	2015	Indiana		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H1607	806	0	1	04	01	H1607_806_0	6		1	05/30/2014	2015.01	05/30/2014 02:19:56 PM Pacific Daylight Time	07/15/2014 03:49:12 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H1607	806	0	2015	Indiana		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H1608	001	0	1	04	01	H1608_001_0	10		1	08/06/2014	2015.01	08/06/2014 07:54:38 AM Central Daylight Time	08/08/2014 09:24:48 AM Central Daylight Time	07/31/2014 04:23:25 PM Central Daylight Time			08/08/2014 02:02:13 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum (PPO)	01	04		1			H1608	001	0	2015	Partial State of Iowa and South Dakota		2	24300	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)293-4748		(866)293-4748		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1608	004	0	1	04	01	H1608_004_0	7		1	08/05/2014	2015.01	08/05/2014 04:47:17 PM Central Daylight Time	08/08/2014 09:27:36 AM Central Daylight Time	07/31/2014 04:23:35 PM Central Daylight Time			08/08/2014 02:02:13 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (PPO)	01	04		1			H1608	004	0	2015	Lincoln, McCook, Minnehaha Counties South Dakota		2	658	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)293-4748		(866)293-4748		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1608	007	0	1	04	01	H1608_007_0	3		1	08/05/2014	2015.01	08/05/2014 04:47:29 PM Central Daylight Time	08/04/2014 07:48:22 PM Central Daylight Time	07/31/2014 04:23:47 PM Central Daylight Time			08/06/2014 01:29:14 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (PPO)	01	04		1			H1608	007	0	2015	Marshall and Story Counties Iowa		2	500	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)293-4748		(866)293-4748		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1608	008	0	1	04	01	H1608_008_0	3		1	08/05/2014	2015.01	08/05/2014 04:47:39 PM Central Daylight Time	08/04/2014 07:50:10 PM Central Daylight Time	07/31/2014 04:23:57 PM Central Daylight Time			08/06/2014 01:29:14 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (PPO)	01	04		1			H1608	008	0	2015	Ida, Monona, Plymouth, Woodbury Counties Iowa		2	500	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)293-4748		(866)293-4748		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1608	801	0	1	04	01	H1608_801_0	1		1	05/21/2014	2015.01	05/21/2014 03:01:08 PM Central Daylight Time	05/30/2014 10:38:24 PM Central Daylight Time				05/31/2014 01:08:41 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/NoRx/Cyear (PPO)	01	04		1			H1608	801	0	2015	Partial State of Iowa and South Dakota		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111000111001110000100	2		1					
H1608	802	0	1	04	01	H1608_802_0	1		1	04/25/2014	2015.01	04/25/2014 10:43:45 AM Central Daylight Time	05/29/2014 11:08:22 PM Central Daylight Time				05/31/2014 01:08:41 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/Rx/Cyear (PPO)	01	04		1			H1608	802	0	2015	Partial State of Iowa and South Dakota		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)293-4748		(866)293-4748		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111000111001110000100	2		1					
H1609	001	0	1	01	01	H1609_001_0	7		1	08/03/2014	2015.01	08/03/2014 09:12:18 PM Central Daylight Time	08/08/2014 09:30:06 AM Central Daylight Time	07/31/2014 04:24:09 PM Central Daylight Time			08/08/2014 02:11:43 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver (HMO)	01	01		1			H1609	001	0	2015	Partial State of Iowa		2	3600	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)294-1211		(866)294-1211		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1609	009	0	1	01	01	H1609_009_0	5		1	08/03/2014	2015.01	08/03/2014 09:12:31 PM Central Daylight Time	08/08/2014 09:41:54 AM Central Daylight Time	07/31/2014 04:24:19 PM Central Daylight Time			08/08/2014 02:11:43 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (HMO)	01	01		1			H1609	009	0	2015	Dallas, Polk, Warren Counties Iowa		2	542	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)294-1211		(866)294-1211		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1609	010	0	1	01	01	H1609_010_0	5		1	08/03/2014	2015.01	08/03/2014 09:17:14 PM Central Daylight Time	08/08/2014 09:45:16 AM Central Daylight Time	08/01/2014 08:26:06 AM Central Daylight Time			08/08/2014 02:11:43 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (HMO)	01	01		1			H1609	010	0	2015	Pottawattamie County Iowa		2	175	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)294-1211		(866)294-1211		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1609	801	0	1	01	01	H1609_801_0	2		1	04/24/2014	2015.01	04/24/2014 05:07:37 PM Central Daylight Time	05/31/2014 09:55:28 AM Central Daylight Time				05/31/2014 04:02:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/NoRx/Cyear (HMO)	01	01		1			H1609	801	0	2015	Partial State of Iowa		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111000111001110000100	2		1					1
H1609	802	0	1	01	01	H1609_802_0	1		1	04/25/2014	2015.01	04/25/2014 08:32:03 AM Central Daylight Time	05/29/2014 08:27:10 PM Central Daylight Time				05/31/2014 01:08:41 AM Central Daylight Time	COVENTRY HEALTH CARE OF IOWA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/Rx/Cyear (HMO)	01	01		1			H1609	802	0	2015	Partial State of Iowa		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(866)294-1211		(866)294-1211		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111000111001110000100	2		1					1
H1651	001	0	1	18	06	H1651_001_0	6		2	08/01/2014	2015.01	08/01/2014 02:32:30 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	001	0	2015	Northeast Iowa		2	5310	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1651	002	0	1	18	06	H1651_002_0	6		2	08/01/2014	2015.01	08/01/2014 02:33:02 PM Central Daylight Time					08/03/2014 08:18:19 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Basic Plan (Cost)	06	18		1			H1651	002	0	2015	Northeast Iowa		2	5	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1651	003	0	1	18	06	H1651_003_0	4		2	08/01/2014	2015.01	08/01/2014 02:33:19 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H1651	003	0	2015	Jo Daviess County		2	1200	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1651	004	0	1	18	06	H1651_004_0	6		2	08/01/2014	2015.01	08/01/2014 02:33:41 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	004	0	2015	Northeast Iowa		2	2750	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1651	005	0	1	18	06	H1651_005_0	4		2	08/01/2014	2015.01	08/01/2014 02:34:01 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H1651	005	0	2015	Jo Daviess County		2	375	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1651	008	0	1	18	06	H1651_008_0	6		2	08/01/2014	2015.01	08/01/2014 02:34:42 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	008	0	2015	Northeast Iowa		2	425	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1651	009	0	1	18	06	H1651_009_0	4		2	08/01/2014	2015.01	08/01/2014 02:34:56 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES HEALTH PLAN, INC.	Medical Associates Health Plan, Inc.	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H1651	009	0	2015	Jo Daviess County		2	100	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H1659	001	0	1	04	01	H1659_001_0	8		1	07/09/2014	2015.01	07/09/2014 04:21:33 PM Eastern Daylight Time	08/04/2014 04:33:07 PM Eastern Daylight Time	08/04/2014 09:09:52 AM Eastern Daylight Time			08/05/2014 03:55:49 PM Eastern Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option One (PPO)	01	04		1			H1659	001	0	2015	Cities: LYH,BE Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	1300	2			2							www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(877)295-1454		(877)295-1454		(877)295-1454		(877)295-1454		(866)236-1069		(866)236-1069		(877)295-1454		(877)295-1454		2					2					
H1659	002	0	1	04	01	H1659_002_0	8		1	07/09/2014	2015.01	07/09/2014 04:22:05 PM Eastern Daylight Time	08/04/2014 04:32:16 PM Eastern Daylight Time	08/04/2014 09:10:09 AM Eastern Daylight Time			08/05/2014 03:55:49 PM Eastern Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Two (PPO)	01	04		1			H1659	002	0	2015	Cities:LYH,BE Counties:AM,AP,BE,CA,CLT,HA,PE,PI		2	2045	2			2							www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(877)295-1454		(877)295-1454		(877)295-1454		(877)295-1454		(866)236-1069		(866)236-1069		(877)295-1454		(877)295-1454		2					2					
H1659	003	0	1	04	01	H1659_003_0	8		1	08/01/2014	2015.01	08/01/2014 04:17:04 PM Eastern Daylight Time	08/05/2014 01:44:20 PM Eastern Daylight Time	08/04/2014 09:10:28 AM Eastern Daylight Time			08/05/2014 03:55:49 PM Eastern Daylight Time	PIEDMONT COMMUNITY HEALTHCARE, INC.	Piedmont Medicare Advantage	www.pchp.net	Piedmont Select Medicare Option Three (PPO)	01	04		1			H1659	003	0	2015	Cities: LYH,BE Counties: AM,AP,BE,CA,CLT,HA,PE,PI		2	2256	2			2							www.pchp.net	www.pchp.net	www.pchp.net	(877)210-1719		(434)947-3671		(877)210-1719		(434)947-3671		(866)494-9927		(866)494-9927		(877)210-1719		(434)947-3671		(877)295-1454		(877)295-1454		(877)295-1454		(877)295-1454		(866)236-1069		(866)236-1069		(877)295-1454		(877)295-1454		2					2					
H1660	001	0	1	01	01	H1660_001_0	9		1	09/12/2014	2015.01	09/12/2014 03:14:08 PM Eastern Daylight Time	09/08/2014 03:39:46 PM Eastern Daylight Time	09/08/2014 03:53:07 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	001	0	2015	Eastern Massachusetts		2	333	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	004	0	1	01	01	H1660_004_0	9		1	09/12/2014	2015.01	09/12/2014 12:24:32 PM Eastern Daylight Time	09/09/2014 10:58:58 AM Eastern Daylight Time	09/08/2014 03:53:56 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	004	0	2015	Central Massachusetts		2	131	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	005	0	1	01	01	H1660_005_0	9		1	09/12/2014	2015.01	09/12/2014 01:52:00 PM Eastern Daylight Time	09/09/2014 05:23:05 PM Eastern Daylight Time	09/09/2014 05:45:15 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	005	0	2015	Southern Maine		2	90	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	009	0	1	01	01	H1660_009_0	9		1	09/12/2014	2015.01	09/12/2014 01:52:09 PM Eastern Daylight Time	09/08/2014 03:43:28 PM Eastern Daylight Time	09/08/2014 03:56:12 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	009	0	2015	Eastern Massachusetts		2	333	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	012	0	1	01	01	H1660_012_0	9		1	09/12/2014	2015.01	09/12/2014 12:26:13 PM Eastern Daylight Time	09/09/2014 11:00:03 AM Eastern Daylight Time	09/08/2014 03:56:58 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	012	0	2015	Central Massachusetts		2	130	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	013	0	1	01	01	H1660_013_0	9		1	09/12/2014	2015.01	09/12/2014 12:27:18 PM Eastern Daylight Time	09/08/2014 03:45:24 PM Eastern Daylight Time	09/08/2014 03:57:51 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H1660	013	0	2015	Southern Maine		2	90	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	801	0	1	01	01	H1660_801_0	5		1	09/12/2014	2015.01	09/12/2014 01:53:35 PM Eastern Daylight Time	09/09/2014 05:40:36 PM Eastern Daylight Time				09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	801	0	2015	National		1	67	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1660	802	0	1	01	01	H1660_802_0	5		1	09/12/2014	2015.01	09/12/2014 01:53:48 PM Eastern Daylight Time	09/09/2014 05:41:51 PM Eastern Daylight Time				09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE INC.	Harvard Pilgrim Health Care, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H1660	802	0	2015	National		1	67	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H1666	001	0	1	04	01	H1666_001_0	12		1	08/05/2014	2015.01	08/05/2014 09:18:10 AM Central Daylight Time	08/05/2014 04:10:20 PM Central Daylight Time	08/05/2014 09:16:56 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	001	0	2015	Austin metro area		2	657	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1666	002	0	1	04	01	H1666_002_0	13		1	07/24/2014	2015.01	07/24/2014 12:05:31 PM Central Daylight Time	08/05/2014 04:11:30 PM Central Daylight Time	08/05/2014 09:19:18 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	002	0	2015	Dallas, Tarrant, Collin, and Denton counties		2	833	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1666	003	0	1	04	01	H1666_003_0	12		1	08/05/2014	2015.01	08/05/2014 09:18:25 AM Central Daylight Time	08/05/2014 04:12:18 PM Central Daylight Time	08/05/2014 09:21:46 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H1666	003	0	2015	Harris, Fort Bend, and Montgomery counties		2	961	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1666	004	0	1	04	01	H1666_004_0	10		1	07/24/2014	2015.01	07/24/2014 12:05:59 PM Central Daylight Time	08/05/2014 03:53:20 PM Central Daylight Time	08/05/2014 09:24:52 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	004	0	2015	Austin Metro Area		2	507	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1666	005	0	1	04	01	H1666_005_0	10		1	08/05/2014	2015.01	08/05/2014 09:35:47 AM Central Daylight Time	08/05/2014 03:56:04 PM Central Daylight Time	08/05/2014 09:27:02 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	005	0	2015	Dallas Metro Area		2	995	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1666	006	0	1	04	01	H1666_006_0	10		1	07/24/2014	2015.01	07/24/2014 12:06:28 PM Central Daylight Time	08/05/2014 03:56:50 PM Central Daylight Time	08/05/2014 09:29:04 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H1666	006	0	2015	Houston Metro Area		2	663	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1666	801	0	1	04	01	H1666_801_0	5		1	06/05/2014	2015.01	06/05/2014 11:49:55 AM Central Daylight Time	07/22/2014 02:48:34 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H1666	801	0	2015	State of Texas		1	50965	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H1666	803	0	1	04	01	H1666_803_0	4		1	06/02/2014	2015.01	06/02/2014 09:45:36 AM Central Daylight Time	07/22/2014 02:50:14 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	BlueCross  Medicare Advantage (PPO)	01	04		1			H1666	803	0	2015	State of Texas		1	50965	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H1666	805	0	1	04	01	H1666_805_0	4		1	06/02/2014	2015.01	06/02/2014 09:45:52 AM Central Daylight Time	07/22/2014 02:52:02 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	Blue Cross Blue Shield of Texas	www.mybluemapd.com	BlueCross  Medicare Advantage (PPO)	01	04		1			H1666	805	0	2015	State of Texas		1	50965	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100011100000000110000001100000000	2		1					
H1692	001	0	1	01	01	H1692_001_0	4		1	08/04/2014	2015.01	08/04/2014 11:38:00 AM Eastern Daylight Time	08/05/2014 11:33:18 AM Eastern Daylight Time	07/31/2014 05:24:29 PM Eastern Daylight Time			08/05/2014 11:42:41 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care of West Virginia	www.wv.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H1692	001	0	2015	Northern West Virginia		2		2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)893-4695		(855)893-4695		(866)295-6206		(866)295-6206		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1692	002	0	1	01	01	H1692_002_0	3		1	08/04/2014	2015.01	08/04/2014 11:38:17 AM Eastern Daylight Time	08/05/2014 11:33:48 AM Eastern Daylight Time	07/31/2014 05:24:40 PM Eastern Daylight Time			08/05/2014 11:42:41 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care of West Virginia	www.wv.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H1692	002	0	2015	Southern West Virginia		2		2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)893-4695		(855)893-4695		(866)295-6206		(866)295-6206		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1692	801	0	1	01	01	H1692_801_0	1		1	05/29/2014	2015.01	05/29/2014 04:00:23 PM Eastern Daylight Time	05/31/2014 08:42:02 AM Eastern Daylight Time				05/31/2014 08:45:26 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care of West Virginia	http://www.wv.chcadvantra.com	Advantra MA Only (HMO)	01	01		1			H1692	801	0	2015	West Virginia		1		2			2							http://providerdirectory.coventry-medicare.com	http://WVFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111111111111111011100	2		1					1
H1692	802	0	1	01	01	H1692_802_0	1		1	05/29/2014	2015.01	05/29/2014 04:01:57 PM Eastern Daylight Time	05/31/2014 08:41:36 AM Eastern Daylight Time				05/31/2014 08:45:26 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Coventry Health Care of West Virginia	http://www.wv.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H1692	802	0	2015	West Virginia		1		2			2							http://providerdirectory.coventry-medicare.com	http://WVFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(800)470-4272		(800)470-4272		(866)295-6206		(866)295-6206		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111111111011100	2		1					1
H1714	001	0	1	20	08	H1714_001_0	1		1	05/20/2014	2015.01	05/20/2014 10:05:33 AM Central Daylight Time		05/17/2014 11:08:29 AM Central Daylight Time			05/20/2014 10:07:42 AM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS	Via Christi HOPE	www.via-christ.org/hope	Via Christi HOPE (PACE)	08	20		1			H1714	001	0	2015	Via Christi HOPE		2		2			2								www.viachristihope.com	www.viachristihope.com									(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111										(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111												
H1714	002	0	1	20	08	H1714_002_0	1		1	05/20/2014	2015.01	05/20/2014 10:06:06 AM Central Daylight Time		05/17/2014 11:15:34 AM Central Daylight Time			05/20/2014 10:07:42 AM Central Daylight Time	VIA CHRISTI HEALTHCARE OUTREACH PROGRAM FOR ELDERS	Via Christi HOPE	www.via-christ.org/hope	Via Christi HOPE (PACE)	08	20		1			H1714	002	0	2015	Sedgwick Co, KS		2		2			2								www.viachristihope.com	www.viachristihope.com									(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111										(316)858-1111		(316)858-1111		(316)858-1111		(316)858-1111												
H1716	001	0	1	04	01	H1716_001_0	3		1	07/10/2014	2015.02	07/10/2014 01:05:20 PM Eastern Daylight Time	08/04/2014 02:31:46 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 09:09:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1716-001 (PPO)	01	04		1			H1716	001	0	2015	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1716	020	0	1	04	01	H1716_020_0	3		1	07/11/2014	2015.02	07/11/2014 09:01:23 AM Eastern Daylight Time	08/04/2014 02:46:04 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 09:09:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H1716-020 (PPO)	01	04		1			H1716	020	0	2015	Select Counties in IL, KS and MO		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1717	009	0	1	04	01	H1717_009_0	5		1	08/04/2014	2015.02	08/04/2014 05:44:23 PM Central Daylight Time	08/04/2014 05:47:57 PM Central Daylight Time	07/31/2014 03:18:42 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H1717	009	0	2015	Johnson and Wyandotte counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1723	001	0	1	48	05	H1723_001_0	10		1	10/31/2014	2015.01	10/31/2014 01:37:11 PM Central Daylight Time					11/03/2014 12:04:53 PM Central Standard Time	ABSOLUTE TOTAL CARE, INC.	Absolute Total Care	http:\\www.mmp.absolutetotalcare.com	Absoute Total Care (Medicare-Medicaid Plan)	05	48		1			H1723	001	0	2015	Statewide		2	500	2			2							http:\\www.mmp.absolutetotalcare.com	http://www.mmp.absolutetotalcare.com	http://www.mmp.absolutetotalcare.com	(855)735-4398		(803)933-3638		(855)735-4398		(803)933-3638		(855)735-4398		(803)933-3638		(855)735-4398		(803)933-3638		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1737	001	0	1	01	01	H1737_001_0	3		1	08/05/2014	2015.01	08/05/2014 09:24:36 AM Central Daylight Time	08/05/2014 06:12:55 PM Central Daylight Time	07/31/2014 04:50:21 PM Central Daylight Time			08/06/2014 01:23:41 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare HMO Low Rx (HMO)	01	01		1			H1737	001	0	2015	Sarpy, NE, Douglas, NE, Pottawattamie, IA		2	2769	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		2					2					2
H1737	003	0	1	01	01	H1737_003_0	3		1	08/05/2014	2015.01	08/05/2014 09:24:42 AM Central Daylight Time	08/05/2014 06:13:41 PM Central Daylight Time	07/31/2014 04:50:25 PM Central Daylight Time			08/06/2014 01:23:41 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Guide HMO Rx (HMO)	01	01		1			H1737	003	0	2015	Sarpy, NE, Douglas, NE, Pottawattamie, IA		2	1187	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)933-8454		(877)933-8454		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		2					2					2
H1737	801	0	1	01	01	H1737_801_0	1		1	05/28/2014	2015.01	05/28/2014 04:13:41 PM Central Daylight Time	05/31/2014 09:20:39 PM Central Daylight Time				06/01/2014 07:31:21 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H1737	801	0	2015	Sarpy, NE, Douglas, NE, Pottawattamie, IA		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352										1	2		2		1					1
H1737	802	0	1	01	01	H1737_802_0	1		1	05/28/2014	2015.01	05/28/2014 04:13:47 PM Central Daylight Time	05/31/2014 09:21:16 PM Central Daylight Time				06/01/2014 07:31:21 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H1737	802	0	2015	Sarpy, NE, Douglas, NE, Pottawattamie, IA		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1					1
H1737	803	0	1	01	01	H1737_803_0	1		1	05/28/2014	2015.01	05/28/2014 04:13:54 PM Central Daylight Time	05/31/2014 09:22:08 PM Central Daylight Time				06/01/2014 07:31:21 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO) - non calendar year (HMO)	01	01		1			H1737	803	0	2015	Sarpy, NE, Douglas, NE, Pottawattamie, IA		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1					1
H1777	007	0	1	01	01	H1777_007_0	12		1	08/05/2014	2015.01	08/05/2014 09:31:43 AM Eastern Daylight Time	08/05/2014 03:56:46 PM Eastern Daylight Time	08/05/2014 03:56:46 PM Eastern Daylight Time			08/05/2014 05:08:49 PM Eastern Daylight Time	CATHOLIC SPECIAL NEEDS PLAN, LLC	ArchCare Advantage	www.archcareadvantage.org	ArchCare  Advantage (HMO SNP)	01	01		1			H1777	007	0	2015	NYC, Westchester, Putnam, Dutchess, Orange, Ononda		2	1700	2			1	1	3	1				www.archcareadvantage.org/for_providers.php	www.archcareadvantage.org/formulary.php	www.archcareadvantage.org/pharmacy_access_information.php	(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H1846	001	0	1	04	01	H1846_001_0	8		1	08/06/2014	2015.01	08/06/2014 12:18:41 PM Eastern Daylight Time	08/04/2014 01:20:00 PM Eastern Daylight Time	08/06/2014 11:21:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold Network Choice (PPO)	01	04		1			H1846	001	0	2015	Greater Central Ohio and Dayton Area		2	315	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1846	003	0	1	04	01	H1846_003_0	9		1	08/06/2014	2015.01	08/06/2014 12:29:36 PM Eastern Daylight Time	08/04/2014 01:20:00 PM Eastern Daylight Time	08/06/2014 11:20:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	MediGold Value Choice (PPO)	01	04		1			H1846	003	0	2015	Select Central Ohio and Dayton Area		2	565	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H1846	801	0	1	04	01	H1846_801_0	2		1	05/30/2014	2015.01	05/30/2014 02:52:08 PM Eastern Daylight Time	06/02/2014 09:25:04 AM Eastern Daylight Time				06/02/2014 12:34:30 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	EGWP MediGold Network Choice (PPO)	01	04		1			H1846	801	0	2015	Greater Central Ohio and Dayton Area		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H1846	802	0	1	04	01	H1846_802_0	2		1	05/28/2014	2015.01	05/28/2014 03:23:52 PM Eastern Daylight Time	06/02/2014 09:26:10 AM Eastern Daylight Time				06/02/2014 12:34:30 PM Eastern Daylight Time	MOUNT CARMEL HEALTH INSURANCE COMPANY	MediGold	www.medigold.com	EGWP MediGold Network Choice Medical Only (PPO)	01	04		1			H1846	802	0	2015	Greater Central Ohio and Dayton Area		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001000000001000000000	2		1					
H1849	017	0	1	01	01	H1849_017_0	12	2	1	08/06/2014	2015.01	08/06/2014 10:42:35 AM Eastern Daylight Time	08/06/2014 04:05:43 PM Eastern Daylight Time	08/06/2014 04:08:16 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H1849	017	0	2015	Select Counties in Kentucky		2	119	2			1	3		1	5			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-6406		(800)797-6406		(800)467-1199		(800)467-1199		(800)797-6406		(800)797-6406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1849	018	0	1	01	01	H1849_018_0	14		1	07/02/2014	2015.01	07/02/2014 01:22:09 PM Central Daylight Time	08/06/2014 01:26:19 PM Eastern Daylight Time	08/06/2014 01:29:43 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage Value (HMO)	01	01		1			H1849	018	0	2015	Select Counties in Kentucky		2	5188	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-6406		(800)797-6406		(800)467-1199		(800)467-1199		(800)797-6406		(800)797-6406		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1849	801	0	1	01	01	H1849_801_0	8		1	05/31/2014	2015.01	05/31/2014 08:49:26 AM Pacific Daylight Time	07/15/2014 01:20:41 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H1849	801	0	2015	Kentucky		1	802	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H1849	803	0	1	01	01	H1849_803_0	8		1	05/31/2014	2015.01	05/31/2014 10:45:04 AM Pacific Daylight Time	07/15/2014 01:20:46 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H1849	803	0	2015	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H1849	804	0	1	01	01	H1849_804_0	8		1	05/31/2014	2015.01	05/31/2014 10:45:59 AM Pacific Daylight Time	07/15/2014 01:20:51 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H1849	804	0	2015	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H1894	001	0	1	01	01	H1894_001_0	9		1	08/05/2014	2015.01	08/05/2014 06:18:38 PM Pacific Daylight Time	08/06/2014 11:19:25 AM Pacific Daylight Time	08/06/2014 01:04:53 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H1894	001	0	2015	King and Snohomish Counties		2	325	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H1894	002	0	1	01	01	H1894_002_0	8	2	1	08/05/2014	2015.01	08/05/2014 06:12:51 PM Pacific Daylight Time	08/06/2014 11:19:50 AM Pacific Daylight Time	08/06/2014 01:04:57 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP WASHINGTON, INC.	AMERIGROUP	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H1894	002	0	2015	King and Snohomish Counties		2	475	2			1	3		1	1			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H1903	011	0	1	01	01	H1903_011_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:29:14 AM Eastern Daylight Time	08/05/2014 11:26:11 AM Eastern Daylight Time	08/01/2014 11:30:43 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF LOUISIANA, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H1903	011	0	2015	New Orleans, Baton Rouge, Lafayette, Alexandria		2	7293	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)530-9488		(866)530-9488		(877)817-5794		(877)817-5794		(866)530-9488		(866)530-9488		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1903	022	0	1	01	01	H1903_022_0	7		1	08/04/2014	2015.02	08/04/2014 01:14:24 PM Eastern Daylight Time	08/05/2014 11:26:25 AM Eastern Daylight Time	08/01/2014 11:30:53 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE OF LOUISIANA, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H1903	022	0	2015	New Orleans, Baton Rouge, Lafayette, Alexandria		2	3723	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)804-5926		(866)804-5926		(877)817-5794		(877)817-5794		(866)804-5926		(866)804-5926		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H1904	001	0	1	20	08	H1904_001_0	1		1	05/29/2014	2015.01	05/29/2014 10:18:14 AM Central Daylight Time		05/29/2014 10:24:00 AM Central Daylight Time			05/29/2014 10:37:20 AM Central Daylight Time	PACE GREATER NEW ORLEANS	Pace Greater New Orleans	http://pacegno.org/	PACE GREATER NEW ORLEANS (PACE)	08	20		1			H1904	001	0	2015	PACE GREATER NEW ORLEANS		2	150	2			2								http://www.pacegno.org	http://www.pacegno.org									(866)395-8509		(504)835-0006		(866)395-8509		(504)835-0006										(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277												
H1904	002	0	1	20	08	H1904_002_0	1		1	05/29/2014	2015.01	05/29/2014 10:12:56 AM Central Daylight Time		05/29/2014 10:24:00 AM Central Daylight Time			05/29/2014 10:37:20 AM Central Daylight Time	PACE GREATER NEW ORLEANS	Pace Greater New Orleans	http://pacegno.org/	PACE GREATER NEW ORLEANS (PACE)	08	20		1			H1904	002	0	2015	PACE GREATER NEW ORLEANS		2	1	2			2								http://www.pacegno.org	http://www.pacegno.org									(866)395-8509		(504)835-0006		(866)395-8509		(504)835-0006										(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277												
H1906	001	0	1	09	04	H1906_001_0	3		1	07/10/2014	2015.02	07/10/2014 03:18:26 PM Eastern Daylight Time	08/02/2014 12:49:29 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	www.humana-medicare.com	Humana Gold Choice H1906-001 (PFFS)	04	09	2	1			H1906	001	0	2015	Select Parishes in Louisiana		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2										2
H1916	001	0	1	48	05	H1916_001_0	9		1	08/29/2014	2015.01	08/29/2014 12:47:35 PM Eastern Daylight Time					08/29/2014 12:49:35 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Fully Integrated Dual Advantage (FIDA) (Medicare-Medicaid Plan)	05	48		1			H1916	001	0	2015	NY City, Nassau, Suffolk and Westchester counties		2	200	2			2							http://www.fideliscare.org/apps/providersearch/	http://www.fideliscare.org/	http://www.fideliscare.org/	(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)247-1447		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		(800)695-8544		2					2					2
H1944	001	0	1	01	01	H1944_001_0	2		1	05/30/2014	2015.01	05/30/2014 04:29:08 PM Central Daylight Time	08/04/2014 02:35:53 PM Central Daylight Time	07/31/2014 03:18:47 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H1944	001	0	2015	Middlesex and Suffolk counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1944	004	0	1	01	01	H1944_004_0	2		1	05/30/2014	2015.01	05/30/2014 04:29:24 PM Central Daylight Time	08/04/2014 02:36:29 PM Central Daylight Time	07/31/2014 03:18:51 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H1944	004	0	2015	Middlesex and Suffolk counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	001	0	1	01	01	H1951_001_0	4		1	08/02/2014	2015.02	08/02/2014 03:09:51 PM Eastern Daylight Time	08/02/2014 12:41:51 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-001 (HMO)	01	01		1			H1951	001	0	2015	New Orleans Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	005	0	1	01	01	H1951_005_0	3		1	08/02/2014	2015.02	08/02/2014 03:10:59 PM Eastern Daylight Time	08/02/2014 12:39:35 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-005 (HMO)	01	01		1			H1951	005	0	2015	Baton Rouge Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	013	0	1	01	01	H1951_013_0	3		1	08/02/2014	2015.02	08/02/2014 04:14:59 PM Eastern Daylight Time	08/02/2014 12:50:58 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-013 (HMO)	01	01		1			H1951	013	0	2015	Shreveport Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	024	0	1	01	01	H1951_024_0	4		1	07/24/2014	2015.02	07/24/2014 10:47:30 AM Eastern Daylight Time	08/02/2014 12:42:27 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-024 (HMO)	01	01		1			H1951	024	0	2015	Tangipahoa Parish		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	025	0	1	01	01	H1951_025_0	3		1	08/02/2014	2015.02	08/02/2014 04:37:31 PM Eastern Daylight Time	08/02/2014 12:43:21 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-025 (HMO)	01	01		1			H1951	025	0	2015	Select Louisiana Parishes		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	028	0	1	01	01	H1951_028_0	3		1	08/02/2014	2015.02	08/02/2014 05:29:58 PM Eastern Daylight Time	08/02/2014 12:43:41 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-028 (HMO)	01	01		1			H1951	028	0	2015	Washington and St. Tammany Parishes		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	030	0	1	01	01	H1951_030_0	2		1	07/11/2014	2015.02	07/11/2014 11:19:31 AM Eastern Daylight Time	07/10/2014 03:14:29 PM Eastern Daylight Time				07/14/2014 12:55:42 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-030 (HMO)	01	01		1			H1951	030	0	2015	Baton Rouge Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H1951	032	0	1	01	01	H1951_032_0	5	2	1	08/04/2014	2015.02	08/04/2014 02:49:48 PM Eastern Daylight Time	08/02/2014 12:45:49 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-032 (HMO SNP)	01	01		1			H1951	032	0	2015	Baton Rouge Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	033	0	1	01	01	H1951_033_0	5	2	1	08/04/2014	2015.02	08/04/2014 02:50:09 PM Eastern Daylight Time	08/02/2014 12:45:31 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-033 (HMO SNP)	01	01		1			H1951	033	0	2015	New Orleans Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	034	0	1	01	01	H1951_034_0	5	2	1	08/04/2014	2015.02	08/04/2014 02:53:58 PM Eastern Daylight Time	08/02/2014 12:45:12 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-034 (HMO SNP)	01	01		1			H1951	034	0	2015	Washington and St. Tammany Parishes		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	035	0	1	01	01	H1951_035_0	3	2	1	08/02/2014	2015.02	08/02/2014 05:34:22 PM Eastern Daylight Time	08/02/2014 12:44:17 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-035 (HMO SNP)	01	01		1			H1951	035	0	2015	Select Louisiana Parishes		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	036	0	1	01	01	H1951_036_0	3		1	08/02/2014	2015.02	08/02/2014 05:35:24 PM Eastern Daylight Time	08/02/2014 01:44:45 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1951-036 (HMO SNP)	01	01		1			H1951	036	0	2015	New Orleans Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	037	0	1	01	01	H1951_037_0	3		1	08/02/2014	2015.02	08/02/2014 05:36:11 PM Eastern Daylight Time	08/02/2014 01:41:59 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1951-037 (HMO SNP)	01	01		1			H1951	037	0	2015	Shreveport Area		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	038	0	1	01	01	H1951_038_0	3		1	08/02/2014	2015.02	08/02/2014 05:37:07 PM Eastern Daylight Time	08/02/2014 12:47:22 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Total Care Advantage H1951-038 (HMO)	01	01		1			H1951	038	0	2015	New Orleans Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	039	0	1	01	01	H1951_039_0	3		1	08/02/2014	2015.02	08/02/2014 05:37:52 PM Eastern Daylight Time	08/02/2014 12:47:03 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:23:48 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Total Care Advantage H1951-039 (HMO)	01	01		1			H1951	039	0	2015	Baton Rouge Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	041	0	1	01	01	H1951_041_0	4	2	1	08/04/2014	2015.02	08/04/2014 04:08:27 PM Eastern Daylight Time	08/02/2014 12:48:16 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H1951-041 (HMO SNP)	01	01		1			H1951	041	0	2015	Louisiana Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	042	0	1	01	01	H1951_042_0	4		1	08/02/2014	2015.02	08/02/2014 02:12:25 PM Eastern Daylight Time	08/02/2014 12:49:46 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus H1951-042 (HMO)	01	01		1			H1951	042	0	2015	Louisiana Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	043	0	1	01	01	H1951_043_0	3		1	08/02/2014	2015.02	08/02/2014 02:21:33 PM Eastern Daylight Time	08/02/2014 01:46:12 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DM H1951-043 (HMO SNP)	01	01		1			H1951	043	0	2015	East Baton Rouge Parish		2		2			1	4		1		00000010000000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	044	0	1	01	01	H1951_044_0	3		1	08/02/2014	2015.02	08/02/2014 02:26:33 PM Eastern Daylight Time	08/02/2014 01:47:44 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H1951-044 (HMO SNP)	01	01		1			H1951	044	0	2015	Select Louisiana Parishes		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1951	801	0	1	01	01	H1951_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:32:44 PM Eastern Daylight Time	07/14/2014 10:42:45 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1951	801	0	2015	Select parishes in Louisiana		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1951	804	0	1	01	01	H1951_804_0	2		1	05/23/2014	2015.02	05/23/2014 02:33:27 PM Eastern Daylight Time	07/14/2014 10:52:17 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Humana Health Benefit Plan of Louisiana, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H1951	804	0	2015	Select parishes in Louisiana		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H1961	002	0	1	01	01	H1961_002_0	6		1	08/06/2014	2015.02	08/06/2014 07:09:15 PM Central Daylight Time	08/06/2014 05:59:28 PM Central Daylight Time	08/06/2014 02:14:46 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Plus (HMO)	01	01		1			H1961	002	0	2015	Southeast Louisiana		2	11000	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	003	0	1	01	01	H1961_003_0	5	2	1	08/06/2014	2015.02	08/06/2014 05:05:55 PM Central Daylight Time	08/06/2014 06:00:00 PM Central Daylight Time	08/06/2014 02:15:16 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Health (HMO SNP)	01	01		1			H1961	003	0	2015	New Orleans Metro and Southeast Louisiana		2	11525	2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	007	0	1	01	01	H1961_007_0	8		1	09/18/2014	2015.02	09/18/2014 10:40:54 AM Central Daylight Time	08/06/2014 06:00:30 PM Central Daylight Time	08/06/2014 02:15:28 PM Central Daylight Time			09/18/2014 11:03:49 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Select (HMO)	01	01		1			H1961	007	0	2015	Southeast Louisiana		2	1600	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	008	0	1	01	01	H1961_008_0	6	2	1	08/06/2014	2015.02	08/06/2014 01:53:50 PM Central Daylight Time	08/06/2014 06:00:58 PM Central Daylight Time	08/06/2014 02:15:40 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice (HMO SNP)	01	01		1			H1961	008	0	2015	Southeast Louisiana		2	500	2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	009	0	1	01	01	H1961_009_0	7		1	08/06/2014	2015.02	08/06/2014 05:43:18 PM Central Daylight Time	08/06/2014 06:01:32 PM Central Daylight Time	08/06/2014 02:15:52 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Platinum #009 (HMO)	01	01		1			H1961	009	0	2015	Orleans, Jefferson Parish		2	3273	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	010	0	1	01	01	H1961_010_0	9	2	1	08/06/2014	2015.02	08/06/2014 06:59:36 PM Central Daylight Time	08/13/2014 01:54:42 PM Central Daylight Time	08/06/2014 02:16:04 PM Central Daylight Time			08/13/2014 02:09:52 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice #010 (HMO SNP)	01	01		1			H1961	010	0	2015	Southwest Louisiana		2		2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	011	0	1	01	01	H1961_011_0	9	2	1	08/13/2014	2015.02	08/13/2014 02:02:06 PM Central Daylight Time	08/13/2014 01:54:50 PM Central Daylight Time	08/06/2014 02:16:16 PM Central Daylight Time			08/13/2014 02:09:52 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Secure Choice #011 (HMO SNP)	01	01		1			H1961	011	0	2015	North and Central Louisiana		2		2			1	3		1	2			www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					1					1
H1961	012	0	1	01	01	H1961_012_0	6		1	08/06/2014	2015.02	08/06/2014 05:57:48 PM Central Daylight Time	08/06/2014 06:03:54 PM Central Daylight Time	08/06/2014 02:16:28 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices Platinum #012 (HMO)	01	01		1			H1961	012	0	2015	East Baton Rouge Parish		2	400	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	014	1	1	01	01	H1961_014_1	6		1	08/06/2014	2015.02	08/06/2014 05:33:30 PM Central Daylight Time	08/06/2014 06:08:54 PM Central Daylight Time	08/06/2014 02:16:42 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	01	01		1			H1961	014	1	2015	Metro New Orleans Area	Metro New Orleans Area	2	21500	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	014	2	1	01	01	H1961_014_2	6		1	08/06/2014	2015.02	08/06/2014 05:51:31 PM Central Daylight Time	08/06/2014 06:09:24 PM Central Daylight Time	08/06/2014 02:16:52 PM Central Daylight Time			08/06/2014 07:10:30 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Choices 65 #14 (HMO)	01	01		1			H1961	014	2	2015	Metro New Orleans Area	St. Tammany Parish	2	6600	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		(800)846-5277		2					2					2
H1961	801	0	1	02	01	H1961_801_0	2		1	04/28/2014	2015.02	04/28/2014 02:15:42 PM Central Daylight Time	06/02/2014 01:05:59 PM Central Daylight Time				06/02/2014 03:10:15 PM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	801	0	2015	Nationwide		1	650	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011100	2		1	1	011111111111111111111111111111011000	2		1
H1961	802	0	1	02	01	H1961_802_0	3		1	04/28/2014	2015.02	04/28/2014 05:29:24 PM Central Daylight Time	07/01/2014 04:59:50 PM Central Daylight Time				07/02/2014 11:40:51 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO-POS)	01	02		1			H1961	802	0	2015	Nationwide		1	650	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011100	2		1	1	011111111111111111111111111111011000	2		1
H1961	803	0	1	01	01	H1961_803_0	3		1	04/28/2014	2015.02	04/28/2014 05:30:42 PM Central Daylight Time	07/01/2014 05:02:02 PM Central Daylight Time				07/02/2014 11:40:51 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	803	0	2015	Nationwide		1	650	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011100	2		1					1
H1961	804	0	1	01	01	H1961_804_0	3		1	05/23/2014	2015.02	05/23/2014 11:58:29 PM Central Daylight Time	07/01/2014 04:57:40 PM Central Daylight Time				07/02/2014 11:40:51 AM Central Daylight Time	PEOPLES HEALTH, INC.	Peoples Health	www.peopleshealth.com	Peoples Health Group Medicare (HMO)	01	01		1			H1961	804	0	2015	Nationwide		1	650	2			2							www.peopleshealth.com/physicians	www.peopleshealth.com/formulary	www.peopleshealth.com/pharmacies	(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(800)222-8600	1	(504)849-4685	1	(866)301-8865		(504)712-7504		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011100	2		1					1
H1969	002	0	1	01	01	H1969_002_0	8		1	08/04/2014	2015.01	08/04/2014 10:25:00 PM Mountain Daylight Time	08/05/2014 10:09:48 AM Pacific Daylight Time	08/01/2014 08:25:06 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO (HMO)	01	01		1			H1969	002	0	2015	Ada and Canyon Counties		2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1969	003	0	1	01	01	H1969_003_0	8		1	07/28/2014	2015.01	07/28/2014 11:29:22 AM Mountain Daylight Time	08/05/2014 10:09:18 AM Pacific Daylight Time	08/01/2014 08:25:30 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUE SHIELD OF IDAHO	Regence BlueShield of Idaho	www.regence.com/medicare	Regence Blue MedAdvantage HMO Plus (HMO)	01	01		1			H1969	003	0	2015	Ada and Canyon Counties		2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H1977	001	0	1	48	05	H1977_001_0	3		1	10/03/2014	2015.01	10/03/2014 09:12:02 AM Eastern Daylight Time					10/03/2014 09:12:44 AM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan MI Health Link (Medicare-Medicaid Plan)	05	48		1			H1977	001	0	2015	Upper Peninsula of Michigan		2	9000	2			2							http://www.uphpplus.com/	http://www.uphpplus.com/formulary.aspx	http://www.uphpplus.com/	(877)349-9324		(906)225-4481		(877)349-9324		(906)225-4481		(877)464-0073		(877)464-0073		(877)349-9324		(877)349-9324		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H1994	001	0	1	02	01	H1994_001_0	9		1	08/06/2014	2015.01	08/06/2014 01:42:04 PM Mountain Daylight Time	08/06/2014 01:05:48 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time			08/11/2014 01:03:13 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	001	0	2015	Counties: Dav, Mor, SLC, Sum, Uta, Was, Web		2	16510	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(801)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2
H1994	002	0	1	02	01	H1994_002_0	8		1	07/18/2014	2015.01	07/18/2014 10:02:23 AM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time			08/06/2014 01:08:20 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	002	0	2015	Iron, Sanpete, Sevier, and Washington Counties		2	2209	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2
H1994	003	0	1	02	01	H1994_003_0	10		1	08/06/2014	2015.01	08/06/2014 01:40:27 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time			08/11/2014 01:03:13 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	003	0	2015	Ada, Boise, Canyon, Elmore, and Gem Counties		2	5387	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(208)429-9900		(855)442-9940		(855)442-9940		(855)442-9900		(208)429-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2
H1994	004	0	1	02	01	H1994_004_0	10		1	08/06/2014	2015.01	08/06/2014 01:37:45 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time			08/11/2014 01:03:13 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	004	0	2015	Twin Falls, Cassia, Minidoka, and Jerome Counties		2	2089	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2
H1994	005	0	1	02	01	H1994_005_0	8		1	08/06/2014	2015.01	08/06/2014 01:26:11 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time			08/11/2014 01:03:13 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	005	0	2015	Box Elder, Cache, Franklin, and Rich Counties		2	803	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		(800)346-4128		(711)-		2					2					2
H1994	006	0	1	02	01	H1994_006_0	8		1	07/18/2014	2015.01	07/18/2014 10:02:09 AM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time	08/06/2014 01:05:51 PM Mountain Daylight Time			08/06/2014 01:08:20 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	006	0	2015	Bingham, Blaine, and Bonneville Counties		2	76	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		(800)377-3529		(711)-		2					2					2
H1994	801	0	1	02	01	H1994_801_0	2		1	06/02/2014	2015.01	06/02/2014 02:00:27 PM Mountain Daylight Time	06/04/2014 06:52:24 PM Mountain Daylight Time				06/04/2014 05:20:35 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	801	0	2015	Utah and Idaho		1	300	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110000011110111011100000110	2		1	1	011100011110000011110111011100000110	2		1
H1994	802	0	1	02	01	H1994_802_0	2		1	05/30/2014	2015.01	05/30/2014 01:48:13 PM Mountain Daylight Time	06/04/2014 06:53:06 PM Mountain Daylight Time				06/04/2014 05:20:35 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	802	0	2015	Utah and Idaho		1	300	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940										(711)-		(711)-		(711)-		(711)-										1	1	011100011110000011110111011100000110	2		1	1	011100011110000011110111011100000110	2		1
H1994	803	0	1	02	01	H1994_803_0	2		1	05/30/2014	2015.01	05/30/2014 01:49:56 PM Mountain Daylight Time	06/04/2014 06:53:36 PM Mountain Daylight Time				06/04/2014 05:20:35 PM Mountain Daylight Time	SELECTHEALTH, INC.	SelectHealth	www.selecthealthadvantage.org	SelectHealth Advantage (HMO-POS)	01	02		1			H1994	803	0	2015	Utah and Idaho		1	300	2			2							www.selecthealthadvantage.org/providers	www.selecthealthadvantage.org/rx	www.selecthealthadvantage.org/benefits	(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(855)442-9900		(855)442-9900		(855)442-9940		(855)442-9940		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110000011110111011100000110	2		1	1	011100011110000011110111011100000110	2		1
H1997	002	0	1	01	01	H1997_002_0	9		1	08/04/2014	2015.01	08/04/2014 11:35:33 PM Mountain Daylight Time	08/05/2014 10:12:44 AM Pacific Daylight Time	08/01/2014 08:26:02 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H1997	002	0	2015	King, Pierce and Snohomish counties		2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2001	001	0	1	04	01	H2001_001_0	4		1	05/30/2014	2015.01	05/30/2014 04:29:42 PM Central Daylight Time	08/04/2014 02:41:03 PM Central Daylight Time	07/31/2014 03:18:54 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H2001	001	0	2015	Cumberland, Kennebec, Sagadahoc and York Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2001	816	0	1	04	01	H2001_816_0	2		1	05/22/2014	2015.02	05/22/2014 09:06:59 AM Central Daylight Time	05/31/2014 01:06:41 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	816	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	817	0	1	04	01	H2001_817_0	2		1	05/22/2014	2015.02	05/22/2014 05:38:04 PM Central Daylight Time	05/31/2014 01:09:15 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	817	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H2001	818	0	1	04	01	H2001_818_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:03 PM Central Daylight Time	05/31/2014 01:12:28 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	818	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	819	0	2	04	01	H2001_819_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:03 PM Central Daylight Time	05/31/2014 01:14:07 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	819	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	820	0	2	04	01	H2001_820_0	2		1	05/07/2014	2015.02	05/07/2014 03:42:25 PM Central Daylight Time	05/31/2014 01:15:27 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	820	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H2001	821	0	2	04	01	H2001_821_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:04 PM Central Daylight Time	05/31/2014 01:17:08 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	821	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	822	0	1	04	01	H2001_822_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:05 PM Central Daylight Time	05/31/2014 01:18:48 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	822	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	823	0	1	04	01	H2001_823_0	2		1	05/07/2014	2015.02	05/07/2014 03:42:28 PM Central Daylight Time	05/31/2014 01:22:22 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	823	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H2001	824	0	1	04	01	H2001_824_0	2		1	05/22/2014	2015.02	05/22/2014 02:37:20 PM Central Daylight Time	05/31/2014 01:23:24 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	824	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	825	0	1	04	01	H2001_825_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:06 PM Central Daylight Time	05/31/2014 01:24:13 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	825	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	826	0	1	04	01	H2001_826_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:07 PM Central Daylight Time	05/31/2014 01:25:03 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	826	0	2015	Select Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	827	0	1	04	01	H2001_827_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:07 PM Central Daylight Time	05/31/2014 01:26:10 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	827	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	828	0	1	04	01	H2001_828_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:08 PM Central Daylight Time	05/31/2014 01:28:31 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	828	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	829	0	1	04	01	H2001_829_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:08 PM Central Daylight Time	05/31/2014 01:29:33 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	829	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	830	0	1	04	01	H2001_830_0	2		1	05/07/2014	2015.02	05/07/2014 03:42:32 PM Central Daylight Time	05/31/2014 01:31:09 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	830	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H2001	831	0	1	04	01	H2001_831_0	2		1	05/22/2014	2015.02	05/22/2014 09:26:01 AM Central Daylight Time	05/31/2014 01:32:43 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		1			H2001	831	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	832	0	2	04	01	H2001_832_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:10 PM Central Daylight Time	05/31/2014 01:33:41 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	832	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2001	833	0	2	04	01	H2001_833_0	2		1	05/07/2014	2015.02	05/07/2014 03:42:35 PM Central Daylight Time	05/31/2014 01:35:08 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	833	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H2001	834	0	2	04	01	H2001_834_0	2		1	04/16/2014	2015.02	05/07/2014 03:42:11 PM Central Daylight Time	05/31/2014 01:36:17 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (PPO)	01	04		2	2		H2001	834	0	2015	National Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H2005	001	0	1	48	05	H2005_001_0	3		1	06/28/2014	2015.02	06/28/2014 01:03:56 PM Eastern Daylight Time					06/28/2014 01:05:25 PM Eastern Daylight Time	FALLON TOTAL CARE, INC.	Fallon Total Care or Fallon Health	www.fallontotalcare.com	Fallon Total Care (Medicare-Medicaid Plan)	05	48		1			H2005	001	0	2015	Hampden, Hampshire and Worcester Counties		2	8750	2			2							www.fallontotalcare.com/findphysician	www.fallontotalcare.com/formulary	www.fallontotalcare.com	(855)508-3390		(855)508-3390		(800)879-0852		(800)879-0852		(855)508-3390		(855)508-3390		(800)879-0852		(800)879-0852		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	002	0	1	01	01	H2012_002_0	3		1	07/10/2014	2015.02	07/10/2014 01:52:58 PM Eastern Daylight Time	08/02/2014 01:12:32 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-002 (HMO)	01	01		1			H2012	002	0	2015	Birmingham Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	003	0	1	01	01	H2012_003_0	3		1	08/02/2014	2015.02	08/02/2014 02:13:45 PM Eastern Daylight Time	08/02/2014 01:12:51 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-003 (HMO)	01	01		1			H2012	003	0	2015	Baldwin, Clarke, and Mobile Counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	006	0	1	01	01	H2012_006_0	4		1	08/02/2014	2015.02	08/02/2014 03:34:48 PM Eastern Daylight Time	08/05/2014 09:36:47 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-006 (HMO)	01	01		1			H2012	006	0	2015	Richland County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	008	0	1	01	01	H2012_008_0	5		1	08/02/2014	2015.02	08/02/2014 08:56:20 AM Eastern Daylight Time	08/03/2014 06:04:10 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-008 (HMO)	01	01		1			H2012	008	0	2015	Richmond Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	009	0	1	01	01	H2012_009_0	3		1	08/02/2014	2015.02	08/02/2014 11:11:51 AM Eastern Daylight Time	08/05/2014 09:39:30 AM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-009 (HMO)	01	01		1			H2012	009	0	2015	Indianapolis Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	011	0	1	01	01	H2012_011_0	5		1	08/02/2014	2015.02	08/02/2014 12:11:05 PM Eastern Daylight Time	08/02/2014 07:58:14 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-011 (HMO)	01	01		1			H2012	011	0	2015	Lexington Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	012	0	1	01	01	H2012_012_0	5		1	08/02/2014	2015.02	08/02/2014 12:20:03 PM Eastern Daylight Time	08/02/2014 07:57:58 PM Eastern Daylight Time	08/04/2014 05:04:09 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-012 (HMO)	01	01		1			H2012	012	0	2015	Louisville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	013	0	1	01	01	H2012_013_0	3		1	07/10/2014	2015.02	07/10/2014 02:30:41 PM Eastern Daylight Time	08/04/2014 12:27:51 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-013 (HMO)	01	01		1			H2012	013	0	2015	Roanoke Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	015	0	1	01	01	H2012_015_0	3		1	07/10/2014	2015.02	07/10/2014 02:14:33 PM Eastern Daylight Time	08/02/2014 01:13:51 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-015 (HMO)	01	01		1			H2012	015	0	2015	Select VA Counties in the Tri-Cities Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	016	0	1	01	01	H2012_016_0	4		1	08/04/2014	2015.02	08/04/2014 09:23:46 AM Eastern Daylight Time	08/02/2014 01:14:33 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-016 (HMO)	01	01		1			H2012	016	0	2015	Select VA Counties in the Tri-Cities Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	021	0	1	01	01	H2012_021_0	4		1	08/02/2014	2015.02	08/02/2014 09:15:31 AM Eastern Daylight Time	08/02/2014 12:07:39 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-021 (HMO)	01	01		1			H2012	021	0	2015	Omaha Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	022	0	1	01	01	H2012_022_0	3		1	07/10/2014	2015.02	07/10/2014 01:26:32 PM Eastern Daylight Time	08/05/2014 02:13:48 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-022 (HMO)	01	01		1			H2012	022	0	2015	Ada, Canyon and Payette counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	027	0	1	01	01	H2012_027_0	3		1	08/02/2014	2015.02	08/02/2014 11:14:00 AM Eastern Daylight Time	08/05/2014 09:44:32 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-027 (HMO)	01	01		1			H2012	027	0	2015	Evansville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	028	0	1	01	01	H2012_028_0	3		1	08/02/2014	2015.02	08/02/2014 11:20:48 AM Eastern Daylight Time	08/05/2014 09:44:12 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-028 (HMO)	01	01		1			H2012	028	0	2015	Fort Wayne Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	029	0	1	01	01	H2012_029_0	3		1	08/02/2014	2015.02	08/02/2014 08:55:40 AM Eastern Daylight Time	08/03/2014 06:08:13 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-029 (HMO)	01	01		1			H2012	029	0	2015	Tidewater area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	030	0	1	02	01	H2012_030_0	5		1	07/10/2014	2015.02	07/10/2014 03:49:21 PM Eastern Daylight Time	08/05/2014 02:16:00 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-030 (HMO-POS)	01	02		1			H2012	030	0	2015	Bonner, Boundary and Kootenai counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	031	0	1	01	01	H2012_031_0	3		1	08/04/2014	2015.02	08/04/2014 01:01:25 PM Eastern Daylight Time	08/05/2014 02:16:47 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-031 (HMO)	01	01		1			H2012	031	0	2015	Clark County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	033	0	1	01	01	H2012_033_0	4		1	08/02/2014	2015.02	08/02/2014 02:11:10 PM Eastern Daylight Time	08/05/2014 02:21:19 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2012	033	0	2015	King County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	035	0	1	01	01	H2012_035_0	3		1	08/04/2014	2015.02	08/04/2014 01:02:51 PM Eastern Daylight Time	08/05/2014 02:17:37 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-035 (HMO)	01	01		1			H2012	035	0	2015	Pierce County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	037	0	1	01	01	H2012_037_0	3		1	08/04/2014	2015.02	08/04/2014 01:13:04 PM Eastern Daylight Time	08/05/2014 02:18:13 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-037 (HMO)	01	01		1			H2012	037	0	2015	Snohomish County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	039	0	1	01	01	H2012_039_0	3		1	08/04/2014	2015.02	08/04/2014 01:06:47 PM Eastern Daylight Time	08/05/2014 02:18:46 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2012	039	0	2015	Spokane County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	042	0	1	01	01	H2012_042_0	5	2	1	07/24/2014	2015.02	07/24/2014 12:59:42 PM Eastern Daylight Time	08/03/2014 06:08:36 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-042 (HMO SNP)	01	01		1			H2012	042	0	2015	Richmond-Tidewater area		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	051	0	1	01	01	H2012_051_0	3		1	07/10/2014	2015.02	07/10/2014 02:04:36 PM Eastern Daylight Time	08/02/2014 01:16:57 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-051 (HMO)	01	01		1			H2012	051	0	2015	Baldwin, Clarke, and Mobile Counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	053	0	1	01	01	H2012_053_0	5	2	1	08/02/2014	2015.02	08/02/2014 04:49:20 PM Eastern Daylight Time	08/05/2014 09:38:15 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-053 (HMO SNP)	01	01		1			H2012	053	0	2015	Spartanburg / Greenville Metro Area		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	054	0	1	01	01	H2012_054_0	3	2	1	07/10/2014	2015.02	07/10/2014 05:12:16 PM Eastern Daylight Time	08/02/2014 01:20:24 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-054 (HMO SNP)	01	01		1			H2012	054	0	2015	Select Counties in Virginia		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	055	0	1	01	01	H2012_055_0	3		1	07/10/2014	2015.02	07/10/2014 02:32:58 PM Eastern Daylight Time	08/03/2014 06:08:57 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-055 (HMO)	01	01		1			H2012	055	0	2015	Charlottesville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	056	0	1	01	01	H2012_056_0	3		1	08/02/2014	2015.02	08/02/2014 11:22:54 AM Eastern Daylight Time	08/05/2014 09:49:17 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-056 (HMO)	01	01		1			H2012	056	0	2015	Marshall and St. Joseph counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	060	0	1	01	01	H2012_060_0	5		1	08/02/2014	2015.02	08/02/2014 08:54:49 AM Eastern Daylight Time	08/03/2014 06:09:20 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H2012-060 (HMO SNP)	01	01		1			H2012	060	0	2015	Richmond - Tidewater area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	064	0	1	01	01	H2012_064_0	4	2	1	08/04/2014	2015.02	08/04/2014 03:45:51 PM Eastern Daylight Time	08/05/2014 09:50:20 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-064 (HMO SNP)	01	01		1			H2012	064	0	2015	Central Indiana Area		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	070	0	1	01	01	H2012_070_0	3	2	1	08/02/2014	2015.02	08/02/2014 02:19:02 PM Eastern Daylight Time	08/02/2014 01:16:15 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-070 (HMO SNP)	01	01		1			H2012	070	0	2015	Greater Alabama		2		2			1	3		1	2			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	080	0	1	01	01	H2012_080_0	3		1	08/04/2014	2015.01	08/04/2014 12:45:53 PM Eastern Daylight Time	08/04/2014 02:51:10 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-080 (HMO)	01	01		1			H2012	080	0	2015	Select Counties in Arkansas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	081	0	1	01	01	H2012_081_0	3	2	1	08/02/2014	2015.01	08/02/2014 02:29:38 PM Eastern Daylight Time	08/04/2014 02:52:44 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-081 (HMO SNP)	01	01		1			H2012	081	0	2015	Select Counties in Arkansas		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	082	0	1	01	01	H2012_082_0	3		1	07/10/2014	2015.01	07/10/2014 01:43:14 PM Eastern Daylight Time	08/04/2014 02:52:02 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-082 (HMO)	01	01		1			H2012	082	0	2015	Select Counties in Arkansas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	084	0	1	01	01	H2012_084_0	3		1	08/04/2014	2015.02	08/04/2014 04:38:35 PM Eastern Daylight Time	08/05/2014 09:53:43 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H2012-084 (HMO SNP)	01	01		1			H2012	084	0	2015	Indianapolis Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	087	0	1	01	01	H2012_087_0	3		1	07/10/2014	2015.02	07/10/2014 02:33:44 PM Eastern Daylight Time	08/03/2014 06:10:49 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-087 (HMO)	01	01		1			H2012	087	0	2015	Northern Virginia area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	088	0	1	01	01	H2012_088_0	3		1	08/02/2014	2015.02	08/02/2014 02:13:08 PM Eastern Daylight Time	08/05/2014 02:23:53 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-088 (HMO)	01	01		1			H2012	088	0	2015	King, Pierce, Clark and Snohomish counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	090	0	1	01	01	H2012_090_0	3		1	07/10/2014	2015.02	07/10/2014 01:35:03 PM Eastern Daylight Time	08/05/2014 02:24:34 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-090 (HMO)	01	01		1			H2012	090	0	2015	Thurston and Lewis counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	093	0	1	01	01	H2012_093_0	3		1	07/10/2014	2015.02	07/10/2014 01:35:40 PM Eastern Daylight Time	08/05/2014 02:22:20 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-093 (HMO)	01	01		1			H2012	093	0	2015	Benton, Franklin, Spokane and Yakima counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	095	0	1	01	01	H2012_095_0	7	2	1	07/10/2014	2015.02	07/10/2014 01:36:19 PM Eastern Daylight Time	08/05/2014 02:22:52 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2012-095 (HMO SNP)	01	01		1			H2012	095	0	2015	Select Counties in Washington		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	096	0	1	01	01	H2012_096_0	4		1	08/02/2014	2015.02	08/02/2014 04:53:21 PM Eastern Daylight Time	08/05/2014 09:39:05 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-096 (HMO)	01	01		1			H2012	096	0	2015	Charleston Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	097	0	1	01	01	H2012_097_0	3		1	07/10/2014	2015.02	07/10/2014 02:22:42 PM Eastern Daylight Time	08/02/2014 01:17:16 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-097 (HMO)	01	01		1			H2012	097	0	2015	Madison and Limestone counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	099	1	1	01	01	H2012_099_1	3		1	08/02/2014	2015.02	08/02/2014 02:17:49 PM Eastern Daylight Time	08/04/2014 02:51:11 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:09:34 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-099 (HMO)	01	01		1			H2012	099	1	2015	Select Counties in Arkansas	Select Counties in Arkansas	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	099	2	1	01	01	H2012_099_2	3		1	07/10/2014	2015.02	07/10/2014 01:07:30 PM Eastern Daylight Time	08/04/2014 02:50:13 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 09:09:34 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-099 (HMO)	01	01		1			H2012	099	2	2015	Select Counties in Arkansas	Select Counties in Arkansas	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	100	4	1	01	01	H2012_100_4	9		1	08/06/2014	2015.01	08/06/2014 03:58:36 PM Eastern Daylight Time	08/05/2014 09:41:31 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-100 (HMO)	01	01		1			H2012	100	4	2015	Spartanburg/Greenville Metro Area	Spartanburg/Greenville Metro Area	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	100	5	1	01	01	H2012_100_5	6		1	08/06/2014	2015.01	08/06/2014 03:59:04 PM Eastern Daylight Time	08/05/2014 09:41:13 AM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2012-100 (HMO)	01	01		1			H2012	100	5	2015	Spartanburg/Greenville Metro Area	Spartanburg/Greenville Metro Area	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2012	801	0	1	01	01	H2012_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:34:10 PM Eastern Daylight Time	07/14/2014 10:46:31 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2012	801	0	2015	Multi-State		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2012	802	0	1	01	01	H2012_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:34:52 PM Eastern Daylight Time	07/14/2014 10:48:39 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2012	802	0	2015	Multi-State		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2029	001	0	1	04	01	H2029_001_0	7		1	08/02/2014	2015.02	08/02/2014 01:22:37 PM Eastern Daylight Time	08/05/2014 09:35:21 AM Eastern Daylight Time	08/04/2014 05:04:11 PM Eastern Daylight Time			08/06/2014 09:10:38 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	HumanaChoice Value H2029-001 (PPO)	01	04		1			H2029	001	0	2015	Puerto Rico Island Wide		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2029	801	0	1	04	01	H2029_801_0	2		1	05/23/2014	2015.02	05/23/2014 03:20:49 PM Eastern Daylight Time	07/14/2014 09:49:21 AM Eastern Daylight Time				07/14/2014 12:54:58 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H2029	801	0	2015	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2029	802	0	1	04	01	H2029_802_0	2		1	05/27/2014	2015.02	05/27/2014 02:35:15 PM Eastern Daylight Time	07/14/2014 09:50:44 AM Eastern Daylight Time				07/14/2014 12:54:58 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H2029	802	0	2015	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2029	803	0	1	04	01	H2029_803_0	2		1	05/27/2014	2015.02	05/27/2014 02:42:17 PM Eastern Daylight Time	07/14/2014 09:51:01 AM Eastern Daylight Time				07/14/2014 12:54:58 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H2029	803	0	2015	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2029	805	0	2	04	01	H2029_805_0	2		1	05/28/2014	2015.02	05/28/2014 03:01:09 PM Eastern Daylight Time	07/14/2014 09:53:07 AM Eastern Daylight Time				07/14/2014 12:54:58 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H2029	805	0	2015	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2029	806	0	2	04	01	H2029_806_0	2		1	05/28/2014	2015.02	05/28/2014 03:01:34 PM Eastern Daylight Time	07/14/2014 09:53:23 AM Eastern Daylight Time				07/14/2014 12:54:58 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H2029	806	0	2015	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2029	807	0	2	04	01	H2029_807_0	2		1	05/28/2014	2015.02	05/28/2014 03:02:29 PM Eastern Daylight Time	07/14/2014 09:53:40 AM Eastern Daylight Time				07/14/2014 12:54:58 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H2029	807	0	2015	Puerto Rico - Island Wide		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2034	001	0	1	01	01	H2034_001_0	7	2	1	08/12/2014	2015.01	08/12/2014 03:15:27 PM Central Daylight Time	08/11/2014 12:20:23 PM Central Daylight Time	08/06/2014 01:28:28 PM Central Daylight Time			08/12/2014 04:18:08 PM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's  Partnership Program (HMO SNP)	01	01		1			H2034	001	0	2015	Eastern Wisconsin		2	160	2			1	3		1	5			www.communitycareinc.org	www.communitycareinc.org/Assets/Formulary.pdf	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H2034	002	0	1	01	01	H2034_002_0	7	2	1	08/12/2014	2015.01	08/12/2014 03:15:30 PM Central Daylight Time	08/11/2014 12:20:23 PM Central Daylight Time	08/06/2014 01:28:28 PM Central Daylight Time			08/12/2014 04:18:08 PM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.communitycareinc.org	Community Care's Partnership Program Disabled (HMO SNP)	01	01		1			H2034	002	0	2015	Eastern Wisconsin		2	143	2			1	3		1	5			www.communitycareinc.org	www.communitycareinc.org/Assets/Formulary.pdf	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H2064	001	0	1	20	08	H2064_001_0	1		1	05/28/2014	2015.01	05/28/2014 09:03:38 AM Eastern Daylight Time		05/27/2014 03:29:08 PM Eastern Daylight Time			05/28/2014 09:06:34 AM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	001	0	2015	LIFE Geisinger		2		2			2								www.lifegeisinger.org	www.lifegeisinger.org									(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790												
H2064	002	0	1	20	08	H2064_002_0	1		1	05/28/2014	2015.01	05/28/2014 09:04:17 AM Eastern Daylight Time		05/27/2014 03:36:56 PM Eastern Daylight Time			05/28/2014 09:06:34 AM Eastern Daylight Time	GEISINGER COMMUNITY HEALTH SERVICES	LIFE Geisinger	www.lifegeisinger.org	LIFE Geisinger (PACE)	08	20		1			H2064	002	0	2015	LIFE Geisinger		2		2			2								www.lifegeisinger.org	www.lifegeisinger.org									(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790										(570)214-9790		(570)214-9790		(570)214-9790		(570)214-9790												
H2108	001	0	1	01	01	H2108_001_0	7	2	1	07/16/2014	2015.02	07/16/2014 03:16:55 PM Eastern Daylight Time	08/04/2014 01:43:04 PM Central Daylight Time	07/31/2014 03:51:57 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H2108	001	0	2015	Maryland, Washington DC and Delaware Counties		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	020	0	1	01	01	H2108_020_0	6		1	07/16/2014	2015.02	07/16/2014 03:17:15 PM Eastern Daylight Time	08/04/2014 01:43:34 PM Central Daylight Time	07/31/2014 03:52:08 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Traditions (HMO SNP)	01	01		1			H2108	020	0	2015	Maryland, Washington DC, and Delaware Counties		2		2			1	1	1	1				www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	022	0	1	01	01	H2108_022_0	6		1	07/16/2014	2015.02	07/16/2014 03:10:54 PM Eastern Daylight Time	08/04/2014 01:44:02 PM Central Daylight Time	07/31/2014 03:52:18 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2108	022	0	2015	Select Maryland Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	028	0	1	01	01	H2108_028_0	5		1	07/16/2014	2015.02	07/16/2014 03:11:08 PM Eastern Daylight Time	08/04/2014 01:44:31 PM Central Daylight Time	07/31/2014 03:52:28 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2108	028	0	2015	Maryland, Washington DC and Delaware Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	029	0	1	01	01	H2108_029_0	5		1	07/16/2014	2015.02	07/16/2014 03:11:23 PM Eastern Daylight Time	05/30/2014 08:22:18 AM Central Daylight Time	07/31/2014 03:52:39 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H2108	029	0	2015	Maryland, Washington DC and Delaware Counties		2		2			1	4		1		00000010000000000000		www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	030	0	1	01	01	H2108_030_0	5		1	07/16/2014	2015.02	07/16/2014 03:11:36 PM Eastern Daylight Time	05/30/2014 08:22:38 AM Central Daylight Time	07/31/2014 03:52:49 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H2108	030	0	2015	Select Maryland Counties		2		2			1	4		1		00000010000000000000		www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	032	0	1	01	01	H2108_032_0	5		1	07/16/2014	2015.02	07/16/2014 03:17:39 PM Eastern Daylight Time	08/04/2014 01:44:59 PM Central Daylight Time	07/31/2014 03:53:00 PM Central Daylight Time			08/05/2014 10:05:47 AM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H2108	032	0	2015	Maryland and Washington DC Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)668-3813		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2108	801	0	1	01	01	H2108_801_0	2		1	05/06/2014	2015.02	05/06/2014 10:35:22 AM Eastern Daylight Time	05/30/2014 08:23:18 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H2108	801	0	2015	Statewide MD, DC and DE		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111011101001110	1	000000101010000000000010000	1					1
H2108	802	0	1	02	01	H2108_802_0	2		1	05/07/2014	2015.02	05/07/2014 04:25:16 PM Eastern Daylight Time	05/30/2014 08:23:39 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H2108	802	0	2015	Statewide MD, DC and DE		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111011101001110	1	000000101010000000000010000	1	1	011111111111111111111111111111111111	1	000000101010000000000010000	1
H2108	803	0	1	01	01	H2108_803_0	2		1	05/04/2014	2015.02	05/04/2014 04:02:24 PM Eastern Daylight Time	05/30/2014 08:23:58 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H2108	803	0	2015	Statewide MD, DC and DE		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111111111011101001110	1	000000101010000000000010000	1					1
H2108	804	0	1	01	01	H2108_804_0	2		1	05/04/2014	2015.02	05/04/2014 04:02:46 PM Eastern Daylight Time	05/30/2014 08:24:18 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H2108	804	0	2015	Statewide MD, DC and DE		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111011101001110	1	000000101010000000000010000	1					1
H2108	805	0	1	02	01	H2108_805_0	2		1	05/06/2014	2015.02	05/06/2014 10:50:51 AM Eastern Daylight Time	05/30/2014 08:24:38 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H2108	805	0	2015	Statewide MD, DC and DE		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111111111011101001110	1	000000101010000000000010000	1	1	011111111111111111111111111111111111	1	000000101010000000000010000	1
H2108	806	0	1	02	01	H2108_806_0	2		1	05/06/2014	2015.02	05/06/2014 10:54:03 AM Eastern Daylight Time	05/30/2014 08:24:57 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH MID-ATLANTIC, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H2108	806	0	2015	Statewide MD, DC and DE		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)313-0973		(800)313-0973		(888)281-7867		(888)281-7867		(877)357-1685		(877)357-1685		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111011101001110	1	000000101010000000000010000	1	1	011111111111111111111111111111111111	1	000000101010000000000010000	1
H2109	001	0	1	20	08	H2109_001_0	1		1	05/19/2014	2015.01	05/19/2014 09:13:56 AM Eastern Daylight Time		05/16/2014 11:44:43 AM Eastern Daylight Time			05/19/2014 09:16:29 AM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	http://www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation. (PACE)	08	20		1			H2109	001	0	2015	Parts of Baltimore City and County, Maryland		2	147	2			2								http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus									(800)550-7044		(410)550-7044		(410)550-7044		(410)550-7044										(800)735-2258		(410)550-0316		(800)735-2258		(410)550-0316												
H2109	002	0	1	20	08	H2109_002_0	1		1	05/19/2014	2015.01	05/19/2014 09:14:38 AM Eastern Daylight Time		05/16/2014 11:54:17 AM Eastern Daylight Time			05/19/2014 09:16:29 AM Eastern Daylight Time	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	Hopkins ElderPlus	http://www.hopkinsbayview.org/hopkinselderplus	The Johns Hopkins Health System Corporation (PACE)	08	20		1			H2109	002	0	2015	Parts of Baltimore City and County, Maryland		2		2			2								http://www.hopkinsbayview.org/hopkinselderplus	http://www.hopkinsbayview.org/hopkinselderplus									(800)550-7044		(410)550-7044		(410)550-7044		(410)550-7044										(800)735-2258		(410)550-0316		(800)735-2258		(410)550-0316												
H2111	001	0	1	04	01	H2111_001_0	5		1	08/05/2014	2015.02	08/05/2014 09:36:52 AM Central Daylight Time	08/04/2014 05:36:52 PM Central Daylight Time	07/31/2014 03:18:57 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2111	001	0	2015	Select Counties in DE, DC, MD and VA		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2111	008	0	1	04	01	H2111_008_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:01:38 AM Central Daylight Time	08/04/2014 03:36:19 PM Central Daylight Time	07/31/2014 03:20:06 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H2111	008	0	2015	Washington, DC		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2112	001	0	1	01	01	H2112_001_0	4		1	07/02/2014	2015.01	07/02/2014 03:36:57 PM Eastern Daylight Time	06/04/2014 01:09:20 PM Eastern Daylight Time				07/11/2014 09:32:46 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H2112	001	0	2015	Southern Maryland		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					2					2
H2112	007	0	1	01	01	H2112_007_0	7		1	08/06/2014	2015.01	08/06/2014 08:43:09 AM Eastern Daylight Time	08/06/2014 04:09:10 PM Eastern Daylight Time	07/31/2014 05:24:51 PM Eastern Daylight Time			08/06/2014 05:11:49 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H2112	007	0	2015	Southern Maryland		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2112	801	0	1	01	01	H2112_801_0	3		1	05/29/2014	2015.01	05/29/2014 09:39:18 AM Eastern Daylight Time	07/17/2014 02:32:34 PM Eastern Daylight Time				07/17/2014 02:40:41 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H2112	801	0	2015	Maryland		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H2112	802	0	1	01	01	H2112_802_0	2		1	05/20/2014	2015.01	05/20/2014 09:42:27 AM Eastern Daylight Time	06/01/2014 04:32:24 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H2112	802	0	2015	Maryland		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H2150	002	0	1	18	06	H2150_002_0	7		1	08/01/2014	2015.01	08/01/2014 10:10:46 AM Eastern Daylight Time		08/01/2014 09:55:34 AM Eastern Daylight Time			08/04/2014 01:06:34 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus High w/Part D (AB) (Cost)	06	18		1			H2150	002	0	2015	DC, MD, VA		2	15501	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2150	009	0	1	18	06	H2150_009_0	7		1	08/01/2014	2015.01	08/01/2014 10:13:42 AM Eastern Daylight Time		08/01/2014 09:57:35 AM Eastern Daylight Time			08/04/2014 01:06:34 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/Part D (AB) (Cost)	06	18		1			H2150	009	0	2015	DC, MD, VA		2	23038	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2150	017	0	1	18	06	H2150_017_0	4		1	07/17/2014	2015.01	07/17/2014 06:47:52 PM Eastern Daylight Time					07/23/2014 02:44:31 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/o D (AB) (Cost)	06	18		1			H2150	017	0	2015	DC, MD, VA		2	1121	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2
H2150	021	0	1	18	06	H2150_021_0	4		1	07/23/2014	2015.01	07/23/2014 01:38:22 PM Eastern Daylight Time					07/23/2014 02:44:31 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus High w/o D (AB) (Cost)	06	18		1			H2150	021	0	2015	DC, MD, VA		2	547	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2
H2150	022	0	1	18	06	H2150_022_0	4		1	07/23/2014	2015.01	07/23/2014 01:38:37 PM Eastern Daylight Time					07/23/2014 02:44:31 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/o D (AB) (Cost)	06	18		1			H2150	022	0	2015	DC, MD, VA		2	1660	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2
H2150	029	0	2	18	06	H2150_029_0	7		1	08/01/2014	2015.01	08/01/2014 10:14:44 AM Eastern Daylight Time		08/04/2014 12:36:09 PM Eastern Daylight Time			08/04/2014 01:06:34 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Std w/Part D (B) (Cost)	06	18		2	1		H2150	029	0	2015	DC, MD, VA		2	47	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2150	030	0	2	18	06	H2150_030_0	4		1	07/17/2014	2015.01	07/17/2014 06:49:10 PM Eastern Daylight Time					07/23/2014 02:44:31 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus Basic w/o D (B) (Cost)	06	18		2	1		H2150	030	0	2015	DC, MD, VA		2	3	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607										(711)-		(711)-		(711)-		(711)-										2					2					2
H2150	801	0	1	18	06	H2150_801_0	2		1	04/22/2014	2015.01	04/22/2014 10:12:56 PM Eastern Daylight Time					05/28/2014 03:24:15 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus GRP w/Part D (AB) (Cost)	06	18		1			H2150	801	0	2015	DC, MD, VA		1	11533	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H2150	805	0	2	18	06	H2150_805_0	2		1	04/22/2014	2015.01	04/22/2014 10:13:07 PM Eastern Daylight Time					05/28/2014 03:24:15 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus GRP w/Part D (B) (Cost)	06	18		2	1		H2150	805	0	2015	DC, MD, VA		1	0	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H2150	806	0	1	18	06	H2150_806_0	2		1	05/14/2014	2015.01	05/14/2014 01:16:44 PM Eastern Daylight Time					05/28/2014 03:24:15 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus FED w/Part D (AB) (Cost)	06	18		1			H2150	806	0	2015	DC, MD, VA		1	11385	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H2150	807	0	2	18	06	H2150_807_0	2		1	05/14/2014	2015.01	05/14/2014 01:17:20 PM Eastern Daylight Time					05/28/2014 03:24:15 PM Eastern Daylight Time	KAISER FNDN HP OF THE MID-ATLANTIC STS	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Medicare Plus FED w/Part D (B) (Cost)	06	18		2	1		H2150	807	0	2015	DC, MD, VA		1	175	2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(888)777-5536		(888)777-5536		(877)408-8607		(877)408-8607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H2161	001	0	1	01	01	H2161_001_0	6	2	1	08/06/2014	2015.01	08/06/2014 07:26:10 AM Eastern Daylight Time	08/06/2014 11:32:12 AM Eastern Daylight Time	08/05/2014 08:32:52 PM Eastern Daylight Time			08/06/2014 04:02:20 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Plus (HMO SNP)	01	01		1			H2161	001	0	2015	Upper Peninsula of Michigan		2	519	2			1	3		1	4			www.uphp.com/medicare	uphp.com/medicare	uphp.com/medicare	(877)349-9324		(906)225-4481		(877)349-9324		(906)225-4481		(877)464-0073		(877)464-0073		(877)349-9324		(877)349-9324		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H2161	002	0	1	01	01	H2161_002_0	7		1	08/06/2014	2015.01	08/06/2014 07:27:27 AM Eastern Daylight Time	08/06/2014 11:34:00 AM Eastern Daylight Time	08/05/2014 08:38:29 PM Eastern Daylight Time			08/06/2014 04:06:06 PM Eastern Daylight Time	UPPER PENINSULA HEALTH PLAN, LLC	Upper Peninsula Health Plan	www.uphp.com/medicare	Upper Peninsula Health Plan Advantage (HMO)	01	01		1			H2161	002	0	2015	Upper Peninsula of Michigan		2	64	2			2							www.uphp.com/medicare	uphp.com/medicare	uphp.com/medicare	(877)349-9324		(906)225-4481		(877)349-9324		(906)225-4481		(877)464-0073		(877)464-0073		(877)349-9324		(877)349-9324		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H2165	005	0	1	01	01	H2165_005_0	4		1	07/17/2014	2015.02	07/17/2014 09:25:17 AM Central Daylight Time	08/04/2014 07:18:52 PM Central Daylight Time	07/31/2014 03:55:16 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred NGA (HMO)	01	01		1			H2165	005	0	2015	Northwest Georgia		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2165	011	0	1	02	01	H2165_011_0	4		1	07/17/2014	2015.02	07/17/2014 09:25:42 AM Central Daylight Time	08/04/2014 07:19:26 PM Central Daylight Time	07/31/2014 03:55:27 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier NGA (HMO-POS)	01	02		1			H2165	011	0	2015	Northwest Georgia		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2165	018	0	1	01	01	H2165_018_0	5		1	07/16/2014	2015.02	07/16/2014 03:09:46 PM Central Daylight Time	05/29/2014 04:59:14 PM Central Daylight Time	07/31/2014 03:58:34 PM Central Daylight Time			08/05/2014 10:38:40 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H2165	018	0	2015	North Texas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2165	019	0	1	01	01	H2165_019_0	5	2	1	07/16/2014	2015.02	07/16/2014 03:09:56 PM Central Daylight Time	06/27/2014 10:58:20 AM Central Daylight Time	07/31/2014 03:58:44 PM Central Daylight Time			08/05/2014 10:38:40 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H2165	019	0	2015	North Texas		2		2			1	3		1	4			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2165	804	0	1	01	01	H2165_804_0	1		1	05/09/2014	2015.02	05/09/2014 05:48:01 PM Central Daylight Time	05/27/2014 12:01:22 PM Central Daylight Time				05/29/2014 08:14:58 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H2165	804	0	2015	Nationwide		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H2165	806	0	1	02	01	H2165_806_0	1		1	05/02/2014	2015.02	05/02/2014 10:38:00 AM Central Daylight Time	05/27/2014 12:02:40 PM Central Daylight Time				05/29/2014 08:14:58 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H2165	806	0	2015	Nationwide		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	1	011111111111111111111111111110000000	1	011111111111111111111100000	1
H2165	807	0	1	01	01	H2165_807_0	1		1	04/23/2014	2015.02	04/23/2014 07:16:06 PM Central Daylight Time	05/27/2014 12:05:04 PM Central Daylight Time				05/29/2014 08:14:58 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H2165	807	0	2015	Nationwide		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H2165	808	0	1	01	01	H2165_808_0	1		1	04/23/2014	2015.02	04/23/2014 07:17:28 PM Central Daylight Time	05/27/2014 12:03:06 PM Central Daylight Time				05/29/2014 08:14:58 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H2165	808	0	2015	Nationwide		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H2165	809	0	1	02	01	H2165_809_0	1		1	05/02/2014	2015.02	05/02/2014 10:38:35 AM Central Daylight Time	05/27/2014 12:03:28 PM Central Daylight Time				05/29/2014 08:14:58 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H2165	809	0	2015	Nationwide		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	1	011111111111111111111111111110000000	1	011111111111111111111100000	1
H2165	810	0	1	02	01	H2165_810_0	1		1	05/02/2014	2015.02	05/02/2014 10:40:25 AM Central Daylight Time	05/27/2014 12:03:51 PM Central Daylight Time				05/29/2014 08:14:58 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H2165	810	0	2015	Nationwide		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	1	011111111111111111111111111110000000	1	011111111111111111111100000	1
H2171	001	0	1	01	01	H2171_001_0	7		1	08/05/2014	2015.01	08/05/2014 04:57:59 AM Eastern Daylight Time	08/04/2014 08:21:24 PM Eastern Daylight Time	07/31/2014 04:31:48 PM Eastern Daylight Time			08/05/2014 05:03:40 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan I (HMO)	01	01		1			H2171	001	0	2015	Dallas Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2171	801	0	1	01	01	H2171_801_0	4		1	05/08/2014	2015.01	05/08/2014 04:38:39 PM Eastern Daylight Time	07/18/2014 11:03:40 AM Eastern Daylight Time				07/18/2014 03:49:09 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	801	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H2171	802	0	1	01	01	H2171_802_0	5		1	05/08/2014	2015.01	05/08/2014 04:39:45 PM Eastern Daylight Time	07/18/2014 11:06:22 AM Eastern Daylight Time				08/06/2014 02:31:54 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	802	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H2171	803	0	1	01	01	H2171_803_0	5		1	05/08/2014	2015.01	05/08/2014 04:39:54 PM Eastern Daylight Time	07/18/2014 11:09:12 AM Eastern Daylight Time				08/06/2014 02:31:54 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	803	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H2171	804	0	1	01	01	H2171_804_0	5		1	05/08/2014	2015.01	05/08/2014 04:40:02 PM Eastern Daylight Time	07/18/2014 11:11:30 AM Eastern Daylight Time				08/06/2014 02:31:54 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N' Care Insurance Company	www.cnchealthplan.com	Emp-only Care N' Care Health Plan Employer Group (HMO)	01	01		1			H2171	804	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H2174	001	0	1	01	01	H2174_001_0	6	2	1	08/06/2014	2015.01	08/06/2014 02:54:33 PM Pacific Daylight Time	08/05/2014 03:15:06 PM Pacific Daylight Time	08/04/2014 08:50:28 AM Pacific Daylight Time			08/06/2014 06:23:22 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Dual (HMO SNP)	01	01		1			H2174	001	0	2015	Lane County		2	3442	2			1	3		1	3		2	www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2
H2174	003	0	1	01	01	H2174_003_0	6		1	08/06/2014	2015.01	08/06/2014 02:54:55 PM Pacific Daylight Time	08/05/2014 03:17:38 PM Pacific Daylight Time	08/04/2014 08:51:48 AM Pacific Daylight Time			08/06/2014 06:23:22 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage TLC ISNP (HMO SNP)	01	01		1			H2174	003	0	2015	Lane County		2	49	2			1	1	1	1				www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2
H2174	004	0	1	01	01	H2174_004_0	5		1	07/23/2014	2015.01	07/23/2014 04:16:08 PM Pacific Daylight Time	06/02/2014 08:38:15 PM Pacific Daylight Time				07/23/2014 06:47:33 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage (HMO)	01	01		1			H2174	004	0	2015	Lane County		2	87	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950										(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951										2					2					2
H2174	005	0	1	01	01	H2174_005_0	6		1	08/06/2014	2015.01	08/06/2014 02:55:25 PM Pacific Daylight Time	08/05/2014 03:25:24 PM Pacific Daylight Time	08/04/2014 08:52:38 AM Pacific Daylight Time			08/06/2014 06:23:22 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage TLC Community ISNP (HMO SNP)	01	01		1			H2174	005	0	2015	Lane County		2	98	2			1	1	2	1				www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2
H2174	009	0	1	01	01	H2174_009_0	6		1	08/06/2014	2015.01	08/06/2014 03:01:44 PM Pacific Daylight Time	08/05/2014 03:29:02 PM Pacific Daylight Time	08/04/2014 08:53:18 AM Pacific Daylight Time			08/06/2014 06:23:22 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Focus (HMO)	01	01		1			H2174	009	0	2015	Lane County		2	30	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					2
H2218	001	0	1	20	08	H2218_001_0	1		1	05/20/2014	2015.01	05/20/2014 10:02:07 AM Eastern Daylight Time		05/16/2014 01:38:46 PM Eastern Daylight Time			05/20/2014 01:21:13 PM Eastern Daylight Time	HARBOR HEALTH SERVICES, INC.	Elder Service Plan of Harbor Health Services, Inc	www.elderserviceplan.org	Harbor Health Elder Service Plan, Dual Eligible (PACE)	08	20		1			H2218	001	0	2015	Norfolk and Suffolk Counties		2		2			2								www.elderserviceplan.org	www.eatonapothecary.com									(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400										(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400												
H2218	002	0	1	20	08	H2218_002_0	2		1	05/20/2014	2015.01	05/20/2014 01:13:57 PM Eastern Daylight Time		05/16/2014 01:36:52 PM Eastern Daylight Time			05/21/2014 11:46:48 AM Eastern Daylight Time	HARBOR HEALTH SERVICES, INC.	Elder Service Plan of Harbor Health Services, Inc	www.elderserviceplan.org	Harbor Health Elder Service Plan, Medicare only (PACE)	08	20		1			H2218	002	0	2015	Norfolk and Suffolk Counties		2		2			2								www.elderserviceplan.org	www.eatonapothecary.com									(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400										(866)714-1277		(617)533-2400		(866)714-1277		(617)533-2400												
H2219	001	0	1	20	08	H2219_001_0	2		1	07/30/2014	2015.02	07/30/2014 12:15:16 PM Eastern Daylight Time		07/29/2014 11:28:04 AM Eastern Daylight Time			07/30/2014 01:06:25 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.summiteldercare.org	Summit ElderCare (PACE)	08	20		1			H2219	001	0	2015	Full: Worc, Hampden, Partial: Hampshire, Middlesex		2	987	2			2								Not Applicable	Not Applicable									(800)698-7566		(508)852-2026		(800)698-7566		(508)368-9690										(800)439-2370		(800)439-2370		(800)889-4106		(800)889-4106												
H2219	002	0	1	20	08	H2219_002_0	2		1	07/30/2014	2015.02	07/30/2014 12:15:45 PM Eastern Daylight Time		07/29/2014 11:28:04 AM Eastern Daylight Time			07/30/2014 01:06:25 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Summit ElderCare or Fallon Health	www.summiteldercare.org	Summit ElderCare (PACE)	08	20		1			H2219	002	0	2015	Full: Worc, Hampden, Partial: Hampshire, Middlesex		2	7	2			2								Not Applicable	Not Applicable									(800)698-7566		(508)852-2026		(800)698-7566		(508)368-9690										(800)439-2370		(800)439-2370		(800)889-4106		(800)889-4106												
H2220	001	0	1	20	08	H2220_001_0	1		1	05/21/2014	2015.01	05/21/2014 10:39:15 AM Eastern Daylight Time		05/20/2014 01:40:09 PM Eastern Daylight Time			05/21/2014 01:12:20 PM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Uphams Corner Health Committee (PACE)	08	20		1			H2220	001	0	2015	Upham's Elder Service Plan		2		2			2								http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/									(617)288-0970	8803	(617)288-0970	8803	(617)288-0970	8820	(617)288-0970	8820									(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206											
H2220	002	0	1	20	08	H2220_002_0	1		1	05/21/2014	2015.01	05/21/2014 10:39:37 AM Eastern Daylight Time		05/20/2014 01:40:12 PM Eastern Daylight Time			05/21/2014 01:12:20 PM Eastern Daylight Time	UPHAMS CORNER HEALTH COMMITTEE, INC.	Uphams Corner Health Committee, Inc.	www.uphamselderserviceplan.org	Uphams Corner Health Committee (PACE)	08	20		1			H2220	002	0	2015	Upham's Elder Service Plan		2		2			2								http://www.uphamscornerhealthctr.com/	http://www.uphamscornerhealthctr.com/									(617)288-0970	8803	(617)288-0970	8803	(617)288-0970	8820	(617)288-0970	8820									(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206	(617)287-8000	8206											
H2221	001	0	1	20	08	H2221_001_0	2		1	05/28/2014	2015.01	05/28/2014 12:06:26 PM Eastern Daylight Time		05/28/2014 10:18:50 AM Eastern Daylight Time			05/28/2014 12:38:23 PM Eastern Daylight Time	ELDER SVC PLAN OF THE CAMBRIDGE HEALTH ALLIANCE	Elder Srvc Pln/Cambridge Health Alliance	Challiance.org	Elder Service Plan of the Cambridge Health (PACE)	08	20		1			H2221	001	0	2015	Counties: Middlesex and Suffolk		2		2			2								none	none									(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850										(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850												
H2221	002	0	1	20	08	H2221_002_0	3		1	05/28/2014	2015.01	05/28/2014 02:58:41 PM Eastern Daylight Time		05/28/2014 10:24:35 AM Eastern Daylight Time			05/28/2014 02:59:10 PM Eastern Daylight Time	ELDER SVC PLAN OF THE CAMBRIDGE HEALTH ALLIANCE	Elder Srvc Pln/Cambridge Health Alliance	Challiance.org	Elder Service Plan of the Cambridge Health (PACE)	08	20		1			H2221	002	0	2015	Counties:  Middlesex and Suffolk		2		2			2								none	none									(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850										(617)575-5850		(617)575-5850		(617)575-5850		(617)575-5850												
H2222	002	0	1	20	08	H2222_002_0	1		1	05/22/2014	2015.01	05/22/2014 01:22:34 PM Eastern Daylight Time		05/21/2014 12:03:26 PM Eastern Daylight Time			05/22/2014 01:24:00 PM Eastern Daylight Time	ELDER SERVICE PLAN OF THE NORTH SHORE	Element Care, Inc	www.pacenorthshore.org	Element Care (PACE)	08	20		1			H2222	002	0	2015	Essex, Middlesex counties		2		2			2								None	www.eatonapothecary.com									(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650									(781)715-6608		(781)715-6608		(781)715-6608		(781)715-6608	6688											
H2222	003	0	1	20	08	H2222_003_0	1		1	05/22/2014	2015.01	05/22/2014 01:22:51 PM Eastern Daylight Time		05/21/2014 11:56:03 AM Eastern Daylight Time			05/22/2014 01:24:00 PM Eastern Daylight Time	ELDER SERVICE PLAN OF THE NORTH SHORE	Element Care, Inc	www.pacenorthshore.org	Element Care (PACE)	08	20		1			H2222	003	0	2015	Essex, Middlesex counties		2		2			2								None	www.eatonapothecary.com									(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650									(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650	(781)715-6608	6650											
H2223	001	0	1	20	08	H2223_001_0	1		1	05/21/2014	2015.01	05/21/2014 01:10:04 PM Eastern Daylight Time		05/20/2014 12:34:34 PM Eastern Daylight Time			05/21/2014 01:14:14 PM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Elder Svc Pln/E Boston Health Center	www.ebnhc.org	East Boston Elder Service Plan (PACE)	08	20		1			H2223	001	0	2015	Chelsea, Revere, East Boston, Everett, Winthrop MA		2		2			2								www.ebnhc.org	www.ebnhc.org									(617)568-4733		(617)568-4733		(617)568-4733		(617)568-4733										(800)919-8646		(800)919-8646		(800)919-8646		(800)919-8646												
H2223	002	0	1	20	08	H2223_002_0	1		1	05/21/2014	2015.01	05/21/2014 01:11:02 PM Eastern Daylight Time		05/20/2014 12:40:25 PM Eastern Daylight Time			05/21/2014 01:14:14 PM Eastern Daylight Time	ELDER SVC PLN/E BOSTON HEALTH CENTER	Elder Svc Pln/E Boston Health Center	www.ebnhc.org	East Boston Elder Service Plan (PACE)	08	20		1			H2223	002	0	2015	Chelsea, Revere, East Boston, Everett, Winthrop MA		2		2			2								www.ebnhc.org	www.ebnhc.org									(617)568-4733		(617)568-4733		(617)568-4733		(617)568-4733										(800)919-8646		(800)919-8646		(800)919-8646		(800)919-8646												
H2224	001	0	1	01	01	H2224_001_0	12	2	1	08/06/2014	2015.01	08/06/2014 12:46:55 PM Eastern Daylight Time	08/06/2014 11:10:20 AM Eastern Daylight Time	08/06/2014 11:10:22 AM Eastern Daylight Time			08/06/2014 12:53:48 PM Eastern Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health (HMO SNP)	01	01		1			H2224	001	0	2015	Brstl, Essx, Midlsex, Nrfolk, Plymth, Sufolk, Worc		2	6040	2			1	3		1	5			www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2224	003	0	1	01	01	H2224_003_0	11	2	1	08/06/2014	2015.01	08/06/2014 12:46:42 PM Eastern Daylight Time	08/06/2014 11:10:29 AM Eastern Daylight Time	08/06/2014 11:10:31 AM Eastern Daylight Time			08/06/2014 12:59:09 PM Eastern Daylight Time	SENIOR WHOLE HEALTH, LLC	Senior Whole Health	www.seniorwholehealth.com	Senior Whole Health NHC (HMO SNP)	01	01		1			H2224	003	0	2015	Brstl, Essx, Midlsex, Nrfolk, Plymth, Sufolk, Worc		2	4561	2			1	3		1	5			www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(888)794-7268		(888)794-7268		(888)566-3526		(888)566-3526		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2225	001	0	1	01	01	H2225_001_0	3	2	1	05/30/2014	2015.01	05/30/2014 09:12:26 AM Eastern Daylight Time	08/05/2014 01:31:53 PM Eastern Daylight Time	08/05/2014 01:31:56 PM Eastern Daylight Time			08/05/2014 01:37:08 PM Eastern Daylight Time	COMMONWEALTH CARE ALLIANCE, INC.	Commonwealth Care Alliance, Inc.	www.commonwealthcaresco.org	Senior Care Options Program (HMO SNP)	01	01		1			H2225	001	0	2015	ESS, FRA, HMD, HMP, MID, NOR, PLY, SUF Counties		2		2			1	3		1	5			www.commonwealthcare.org	www.commonwealthcaresco.org/pharmacy-program/formulary	www.commonwealthcaresco.org/pharmacy-program/overview	(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(866)610-2273		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000110000000010001100000000	2		2					1
H2226	001	0	1	01	01	H2226_001_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:01:45 AM Central Daylight Time	08/12/2014 09:36:25 AM Central Daylight Time	07/31/2014 03:20:11 PM Central Daylight Time			08/12/2014 02:49:26 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare Community Plan	www.UHCMedicareSolutions.com	UnitedHealthcare Senior Care Options (HMO SNP)	01	01		1			H2226	001	0	2015	Boston, Springfield and Worcester Metro Areas		2		2			1	3		1	5			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(888)867-5511		(888)867-5511		(888)834-3721		(888)834-3721		(888)867-5511		(888)867-5511		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2228	001	0	1	04	01	H2228_001_0	4		1	07/18/2014	2015.02	07/18/2014 09:25:39 AM Central Daylight Time	08/04/2014 05:40:43 PM Central Daylight Time	07/31/2014 03:20:16 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	001	0	2015	Boston, Springfield, New Bedford, Worcester areas		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2228	002	0	1	04	01	H2228_002_0	5		1	07/18/2014	2015.02	07/18/2014 09:25:53 AM Central Daylight Time	08/04/2014 05:41:21 PM Central Daylight Time	07/31/2014 03:20:22 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2228	002	0	2015	Bristol, Kent, Providence and Washington counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2230	002	0	1	04	01	H2230_002_0	7		1	08/06/2014	2015.01	08/06/2014 05:44:53 PM Eastern Daylight Time	08/06/2014 10:37:00 AM Eastern Daylight Time	08/01/2014 08:58:00 AM Eastern Daylight Time			08/06/2014 05:53:37 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue PlusRx (PPO)	01	04		1			H2230	002	0	2015	Massachusetts except Berkshire Dukes and Nantucket		2	13100	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					
H2230	016	0	1	04	01	H2230_016_0	6		1	07/24/2014	2015.01	07/24/2014 12:55:38 PM Eastern Daylight Time	08/06/2014 10:38:00 AM Eastern Daylight Time	08/01/2014 08:58:00 AM Eastern Daylight Time			08/06/2014 06:03:08 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue ValueRx (PPO)	01	04		1			H2230	016	0	2015	Massachusetts except Berkshire Dukes and Nantucket		2	8700	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					
H2230	017	0	1	04	01	H2230_017_0	6		1	08/06/2014	2015.01	08/06/2014 05:42:31 PM Eastern Daylight Time	08/06/2014 10:39:00 AM Eastern Daylight Time	08/01/2014 08:58:00 AM Eastern Daylight Time			08/06/2014 06:07:55 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue SaverRx (PPO)	01	04		1			H2230	017	0	2015	Massachusetts except Berkshire Dukes and Nantucket		2	4000	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					
H2230	801	0	1	04	01	H2230_801_0	4		1	05/23/2014	2015.01	05/23/2014 04:42:15 PM Eastern Daylight Time	06/02/2014 01:16:00 PM Eastern Daylight Time				06/02/2014 04:07:46 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue (PPO)	01	04		1			H2230	801	0	2015	National Network		1	2749	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					
H2230	809	0	1	04	01	H2230_809_0	5		1	05/23/2014	2015.01	05/23/2014 06:45:16 PM Eastern Daylight Time	07/14/2014 03:13:51 PM Eastern Daylight Time				07/14/2014 03:56:29 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare PPO Blue (PPO)	01	04		1			H2230	809	0	2015	National Network		1	200	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254										2					2					
H2237	001	0	1	01	01	H2237_001_0	8	2	1	08/07/2014	2015.01	08/07/2014 10:45:33 AM Central Daylight Time	08/05/2014 07:13:15 PM Central Daylight Time	08/05/2014 07:13:13 PM Central Daylight Time			08/07/2014 11:04:06 AM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icare-wi.org	iCare Medicare Plan (HMO SNP)	01	01		1			H2237	001	0	2015	iCare Medicare Plan		2	5300	2			1	3		1	2			www.icare-wi.org	www.icare-wi.org	www.icare-wi.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2
H2237	007	0	1	01	01	H2237_007_0	8	2	1	08/05/2014	2015.01	08/05/2014 11:39:22 AM Central Daylight Time	08/05/2014 07:13:15 PM Central Daylight Time	08/05/2014 07:13:11 PM Central Daylight Time			08/07/2014 11:04:06 AM Central Daylight Time	INDEPENDENT CARE HEALTH PLAN, INC.	iCare	www.icare-wi.org	iCare Family Care Partnership (HMO SNP)	01	01		1			H2237	007	0	2015	iCare Family Care Partnership		2	500	2			1	3		1	5			www.icare-wi.org	www.icare-wi.org	www.icare-wi.org	(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)777-4376		(414)223-4847		(888)241-9637		(414)223-4847		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2
H2241	003	1	1	01	01	H2241_003_1	9		1	08/21/2014	2015.01	08/21/2014 02:49:31 PM Pacific Daylight Time	09/06/2014 02:01:26 PM Pacific Daylight Time	09/06/2014 01:56:53 PM Pacific Daylight Time			09/06/2014 03:51:09 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State Medicare Health Plan	www.GoldenStateMHP.com	Golden State Medicare Health Plan, Golden (HMO)	01	01		1			H2241	003	1	2015	LA/OC/RV/CC/SLO Counties-Partial	LA/OC/RV/CC Counties-Partial	2	1900	2			2							http://www.GoldenStateMHP.com/	www.goldenstatemhp.com	www.goldenstatemhp.com	(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		2					2					2
H2241	003	2	1	01	01	H2241_003_2	8		1	08/29/2014	2015.01	08/29/2014 12:19:33 PM Pacific Daylight Time	08/01/2014 08:34:05 AM Pacific Daylight Time	08/28/2014 12:35:32 PM Pacific Daylight Time			09/05/2014 03:45:34 PM Pacific Daylight Time	GOLDEN STATE MEDICARE HEALTH PLAN	Golden State Medicare Health Plan	www.GoldenStateMHP.com	Golden State Medicare Health Plan, Golden (HMO)	01	01		1			H2241	003	2	2015	LA/OC/RV/CC/SLO/ST/SJ Counties-Partial	SLO County-Partial	2	1800	2			2							http://www.GoldenStateMHP.com/	www.goldenstatemhp.com	www.goldenstatemhp.com	(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)541-4111		(562)799-0319		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		(877)551-4111		2					2					2
H2256	001	1	1	01	01	H2256_001_1	13		1	08/05/2014	2015.01	08/05/2014 05:08:40 PM Eastern Daylight Time	08/06/2014 12:09:06 PM Eastern Daylight Time	07/31/2014 04:33:16 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	1	2015	Most of Massachusetts	Essex and Suffolk counties	2	90000	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	001	2	1	01	01	H2256_001_2	13		1	07/25/2014	2015.01	07/25/2014 10:15:46 AM Eastern Daylight Time	08/06/2014 12:09:24 PM Eastern Daylight Time	07/31/2014 04:33:36 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	2	2015	Most of Massachusetts	BRIST, MIDD, NORFK, PLYM, BARN count	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	001	6	1	01	01	H2256_001_6	13		1	07/25/2014	2015.01	07/25/2014 10:16:04 AM Eastern Daylight Time	08/06/2014 12:09:40 PM Eastern Daylight Time	07/31/2014 04:33:58 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx Plus (HMO)	01	01		1			H2256	001	6	2015	Most of Massachusetts	Hampden and Hampshire counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	015	1	1	01	01	H2256_015_1	13		1	07/25/2014	2015.01	07/25/2014 10:16:25 AM Eastern Daylight Time	08/06/2014 12:09:58 PM Eastern Daylight Time	07/31/2014 04:34:20 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	1	2015	Most of Massachusetts	Essex and Suffolk counties	2	90000	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	015	2	1	01	01	H2256_015_2	13		1	07/25/2014	2015.01	07/25/2014 10:16:48 AM Eastern Daylight Time	08/06/2014 12:10:14 PM Eastern Daylight Time	07/31/2014 04:34:42 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	2	2015	Most of Massachusetts	BRIST, MIDDLESEX, NORFK, PLYM, BARNS counties	2	90000	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	015	6	1	01	01	H2256_015_6	13		1	07/25/2014	2015.01	07/25/2014 10:17:30 AM Eastern Daylight Time	08/06/2014 12:10:30 PM Eastern Daylight Time	07/31/2014 04:35:02 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	015	6	2015	Most of Massachusetts	Hampden and Hampshire counties	2	90000	2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	016	1	1	01	01	H2256_016_1	12		1	07/25/2014	2015.01	07/25/2014 10:17:50 AM Eastern Daylight Time	06/02/2014 12:29:52 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	1	2015	Most of Massachusetts	Essex and, Suffolk counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	016	2	1	01	01	H2256_016_2	12		1	07/25/2014	2015.01	07/25/2014 10:18:21 AM Eastern Daylight Time	06/02/2014 12:30:12 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	2	2015	Most of Massachusetts	BRIST, MIDD, NORFK, PLYM, BARNS counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	016	6	1	01	01	H2256_016_6	12		1	07/25/2014	2015.01	07/25/2014 10:18:53 AM Eastern Daylight Time	06/02/2014 12:30:30 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	016	6	2015	Most of Massachusetts	Hampden and Hampshire counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	018	1	1	01	01	H2256_018_1	14		1	07/25/2014	2015.01	07/25/2014 10:23:14 AM Eastern Daylight Time	08/06/2014 12:10:48 PM Eastern Daylight Time	07/31/2014 04:35:24 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	1	2015	Most of Massachusetts	Essex and Suffolk counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	018	7	1	01	01	H2256_018_7	14		1	07/25/2014	2015.01	07/25/2014 10:23:29 AM Eastern Daylight Time	08/06/2014 12:11:04 PM Eastern Daylight Time	07/31/2014 04:35:48 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	7	2015	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	018	8	1	01	01	H2256_018_8	14		1	07/25/2014	2015.01	07/25/2014 10:23:58 AM Eastern Daylight Time	08/06/2014 12:11:20 PM Eastern Daylight Time	07/31/2014 04:36:10 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	018	8	2015	Most of Massachusetts	Hampden and Hampshire counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	019	1	1	01	01	H2256_019_1	12		1	07/25/2014	2015.01	07/25/2014 10:24:25 AM Eastern Daylight Time	06/02/2014 12:31:38 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	1	2015	Most of Massachusetts	Essex and Suffolk counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	019	7	1	01	01	H2256_019_7	12		1	07/25/2014	2015.01	07/25/2014 10:28:12 AM Eastern Daylight Time	06/02/2014 12:31:56 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	7	2015	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	019	8	1	01	01	H2256_019_8	12		1	07/25/2014	2015.01	07/25/2014 10:29:08 AM Eastern Daylight Time	06/02/2014 12:32:12 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	019	8	2015	Most of Massachusetts	Hampden and Hampshire counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	026	1	1	01	01	H2256_026_1	14		1	08/05/2014	2015.01	08/05/2014 03:11:20 PM Eastern Daylight Time	08/06/2014 02:05:24 PM Eastern Daylight Time	07/31/2014 04:36:32 PM Eastern Daylight Time			08/07/2014 09:23:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	1	2015	Most of Massachusetts	Essex and Suffolk counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	026	2	1	01	01	H2256_026_2	14		1	08/05/2014	2015.01	08/05/2014 03:12:39 PM Eastern Daylight Time	08/06/2014 02:05:40 PM Eastern Daylight Time	07/31/2014 04:36:54 PM Eastern Daylight Time			08/07/2014 09:23:22 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	2	2015	Most of Massachusetts	BARN, BRIS, MIDD, NORF, PLYM counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	026	3	1	01	01	H2256_026_3	14		1	08/05/2014	2015.01	08/05/2014 03:14:15 PM Eastern Daylight Time	08/06/2014 03:49:48 PM Eastern Daylight Time	07/31/2014 04:37:18 PM Eastern Daylight Time			08/06/2014 04:00:03 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	026	3	2015	Most of Massachusetts	Hampden and Hampshire counties	2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	028	0	1	01	01	H2256_028_0	13		1	08/06/2014	2015.01	08/06/2014 08:52:30 AM Eastern Daylight Time	08/06/2014 02:05:58 PM Eastern Daylight Time	07/31/2014 04:37:40 PM Eastern Daylight Time			08/06/2014 02:51:41 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Saver Rx (HMO)	01	01		1			H2256	028	0	2015	BARN, BRIS, MIDD, NORF, PLYM, ESSEX, SUFF, WORC		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	029	0	1	01	01	H2256_029_0	12	2	1	08/06/2014	2015.01	08/06/2014 03:29:04 PM Eastern Daylight Time	08/06/2014 12:04:13 PM Eastern Daylight Time	08/06/2014 12:04:24 PM Eastern Daylight Time			08/06/2014 03:33:10 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	thpmp.org/sco	Tufts Health Plan Senior Care Options (HMO SNP)	01	01		1			H2256	029	0	2015	Most of Massachusetts		2		2			1	3		1	5			thpmp.org/sco	thpmp.org/sco	thpmp.org/sco	(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(855)670-5934		(855)670-5934		(855)670-5935		(855)670-5935		(855)670-5936		(855)670-5936		(855)670-5940		(855)670-5940		(855)670-5936		(855)670-5936		(855)670-5940		(855)670-5940		2					2					2
H2256	033	0	1	01	01	H2256_033_0	13		1	07/25/2014	2015.01	07/25/2014 10:37:28 AM Eastern Daylight Time	08/06/2014 12:11:36 PM Eastern Daylight Time	07/31/2014 04:38:02 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime Rx (HMO)	01	01		1			H2256	033	0	2015	WORCESTER County		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	034	0	1	01	01	H2256_034_0	13		1	07/25/2014	2015.01	07/25/2014 10:37:47 AM Eastern Daylight Time	08/06/2014 12:11:54 PM Eastern Daylight Time	07/31/2014 04:38:26 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value Rx (HMO)	01	01		1			H2256	034	0	2015	WORCESTER County		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	036	0	1	01	01	H2256_036_0	14		1	07/25/2014	2015.01	07/25/2014 10:39:27 AM Eastern Daylight Time	08/06/2014 12:12:10 PM Eastern Daylight Time	07/31/2014 04:39:04 PM Eastern Daylight Time			08/06/2014 12:42:44 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic Rx (HMO)	01	01		1			H2256	036	0	2015	WORCESTER County		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	039	0	1	01	01	H2256_039_0	12		1	07/25/2014	2015.01	07/25/2014 10:39:42 AM Eastern Daylight Time	06/02/2014 12:34:26 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Prime No Rx (HMO)	01	01		1			H2256	039	0	2015	Worcester County		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(855)670-5934		(855)670-5934		(877)218-4835		(877)218-4835										(855)670-5936		(855)670-5936		(888)899-8977		(888)899-8977										2					2					2
H2256	040	0	1	01	01	H2256_040_0	12		1	07/25/2014	2015.01	07/25/2014 10:39:59 AM Eastern Daylight Time	06/02/2014 12:34:42 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Value No Rx (HMO)	01	01		1			H2256	040	0	2015	Worcester County		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(855)670-5934		(855)670-5934		(877)218-4835		(877)218-4835										(855)670-5936		(855)670-5936		(888)899-8977		(888)899-8977										2					2					2
H2256	041	0	1	01	01	H2256_041_0	12		1	07/25/2014	2015.01	07/25/2014 10:40:24 AM Eastern Daylight Time	07/02/2014 04:13:22 PM Eastern Daylight Time				07/25/2014 11:40:11 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	01	01		1			H2256	041	0	2015	Worcester County		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(855)670-5934		(855)670-5934		(877)218-4835		(877)218-4835										(855)670-5936		(855)670-5936		(888)899-8977		(888)899-8977										2					2					2
H2256	042	0	1	01	01	H2256_042_0	11		1	07/25/2014	2015.01	07/25/2014 10:40:37 AM Eastern Daylight Time	07/02/2014 04:13:46 PM Eastern Daylight Time				07/25/2014 11:30:52 AM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Basic No Rx (HMO)	01	01		1			H2256	042	0	2015	Essex and Suffolk Counties		2		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	801	0	1	01	01	H2256_801_0	6		1	05/30/2014	2015.01	05/30/2014 09:42:13 AM Eastern Daylight Time	06/02/2014 02:54:28 PM Eastern Daylight Time				06/02/2014 03:22:11 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Rx (HMO)	01	01		1			H2256	801	0	2015	Most of Massachusetts		1		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2256	802	0	1	01	01	H2256_802_0	4		1	05/30/2014	2015.01	05/30/2014 09:42:25 AM Eastern Daylight Time	06/02/2014 12:35:50 PM Eastern Daylight Time				06/02/2014 02:00:01 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO (HMO)	01	01		1			H2256	802	0	2015	Most of Massachusetts		1		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977										2					2					2
H2256	803	0	1	01	01	H2256_803_0	6		1	05/30/2014	2015.01	05/30/2014 09:42:38 AM Eastern Daylight Time	06/02/2014 03:04:34 PM Eastern Daylight Time				06/02/2014 03:22:11 PM Eastern Daylight Time	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Tufts Health Plan or Tufts Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred HMO Rx (HMO)	01	01		1			H2256	803	0	2015	Most of Massachusetts		1		2			2							tuftsmedicarepreferred.org	tuftsmedicarepreferred.org	tuftsmedicarepreferred.org/druglist.php	(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977		2					2					2
H2261	005	0	1	01	01	H2261_005_0	8		1	07/24/2014	2015.01	07/24/2014 11:02:10 AM Eastern Daylight Time	08/06/2014 10:44:00 AM Eastern Daylight Time	08/01/2014 08:58:00 AM Eastern Daylight Time			08/06/2014 06:31:28 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue PlusRx (HMO)	01	01		1			H2261	005	0	2015	Massachusetts except Berkshire Dukes and Nantucket		2	5900	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					2
H2261	019	0	1	01	01	H2261_019_0	9		1	07/24/2014	2015.01	07/24/2014 11:46:20 AM Eastern Daylight Time	08/06/2014 12:51:00 PM Eastern Daylight Time	08/01/2014 08:58:00 AM Eastern Daylight Time			08/06/2014 06:35:46 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue ValueRx (HMO)	01	01		1			H2261	019	0	2015	Massachusetts except Berkshire Dukes and Nantucket		2	1800	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		2					2					2
H2261	801	0	1	01	01	H2261_801_0	4		1	06/20/2014	2015.01	06/20/2014 01:01:26 PM Eastern Daylight Time	06/02/2014 01:13:00 PM Eastern Daylight Time				06/20/2014 01:02:09 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	01	01		1			H2261	801	0	2015	Massachusetts except Berkshire Dukes and Nantucket		1	2700	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254		1	1	011100011011101111110011001100000000	1	000000001010000000000000000	1					1
H2261	809	0	1	01	01	H2261_809_0	5		1	05/28/2014	2015.01	05/28/2014 07:47:04 AM Eastern Daylight Time	07/14/2014 03:13:22 PM Eastern Daylight Time				07/14/2014 03:42:11 PM Eastern Daylight Time	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Blue Cross Blue Shield of Massachusetts	www.bluecrossma.com/medicare	Medicare HMO Blue (HMO)	01	01		1			H2261	809	0	2015	Massachusetts except Berkshire Dukes and Nantucket		1	50	2			2							www.bcbsma.com	http://www.bluecrossma.com/formularies/medicare	http://www.bluecrossma.com/pharmacyfinder	(800)200-4255		(800)200-4255		(800)678-2265		(800)678-2265										(800)522-1254		(800)522-1254		(800)522-1254		(800)522-1254										1	1	011100011011101111110011001100000000	1	000000001010000000000000000	1					1
H2312	004	0	1	01	01	H2312_004_0	12		1	08/13/2014	2015.01	08/13/2014 03:05:44 PM Eastern Daylight Time	08/04/2014 03:31:21 PM Eastern Daylight Time	08/04/2014 06:12:50 PM Eastern Daylight Time			08/13/2014 03:45:38 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Henry Ford (HMO)	01	01		1			H2312	004	0	2015	Southeastern Michigan (3 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H2312	006	0	1	01	01	H2312_006_0	10		1	08/13/2014	2015.01	08/13/2014 03:35:08 PM Eastern Daylight Time	07/01/2014 02:35:12 PM Eastern Daylight Time				08/13/2014 03:45:38 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Henry Ford (HMO)	01	01		1			H2312	006	0	2015	Southeastern Michigan (3 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777										2					2					2
H2312	007	0	1	02	01	H2312_007_0	10		1	08/13/2014	2015.01	08/13/2014 03:36:03 PM Eastern Daylight Time	08/04/2014 03:34:29 PM Eastern Daylight Time	08/04/2014 06:12:31 PM Eastern Daylight Time			08/13/2014 03:45:38 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Expanded Network (HMO-POS)	01	02		1			H2312	007	0	2015	Southeastern Michigan (9 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H2312	010	0	1	02	01	H2312_010_0	11		1	08/13/2014	2015.01	08/13/2014 03:37:00 PM Eastern Daylight Time	08/04/2014 03:53:25 PM Eastern Daylight Time	08/04/2014 06:12:20 PM Eastern Daylight Time			08/13/2014 03:45:38 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Expanded Network (HMO-POS)	01	02		1			H2312	010	0	2015	Southeastern Michigan (9 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H2312	012	0	1	02	01	H2312_012_0	10		1	08/13/2014	2015.01	08/13/2014 03:37:45 PM Eastern Daylight Time	08/04/2014 03:57:54 PM Eastern Daylight Time	08/04/2014 06:12:07 PM Eastern Daylight Time			08/13/2014 03:45:38 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Expanded Network (HMO-POS)	01	02		1			H2312	012	0	2015	Southeastern Michigan (9 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H2312	801	0	1	01	01	H2312_801_0	9		1	06/02/2014	2015.01	06/02/2014 11:01:40 AM Eastern Daylight Time	07/01/2014 02:36:10 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	801	0	2015	Macomb, Oakland and Wayne Counties		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777										1	1	011100000100000000110110001100000100	2		1					2
H2312	803	0	1	01	01	H2312_803_0	9		1	06/02/2014	2015.01	06/02/2014 11:02:02 AM Eastern Daylight Time	07/01/2014 02:36:20 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	803	0	2015	Macomb, Oakland and Wayne Counties		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		1	1	011100000100000000110110001100000100	2		1					1
H2312	805	0	1	01	01	H2312_805_0	8		1	06/02/2014	2015.01	06/02/2014 11:02:15 AM Eastern Daylight Time	07/01/2014 02:36:32 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	805	0	2015	Southeastern Michigan (9 Counties)		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777										1	1	011100000000100000000000000000000000	2		1					2
H2312	807	0	1	01	01	H2312_807_0	8		1	06/02/2014	2015.01	06/02/2014 11:06:01 AM Eastern Daylight Time	07/01/2014 02:36:46 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org/Medicare	HAP Senior Plus - Group Only (HMO)	01	01		1			H2312	807	0	2015	Southeastern Michigan (9 Counties)		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		1	1	011100000100000000110110001100000100	2		1					1
H2312	809	0	1	01	01	H2312_809_0	8		1	06/02/2014	2015.01	06/02/2014 11:06:20 AM Eastern Daylight Time	07/01/2014 02:36:57 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org	HAP Senior Plus - Group Non Cal (HMO) (HMO)	01	01		1			H2312	809	0	2015	Wayne, Oakland , Macomb		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		1	1	011100000100000000110110001100000100	2		1					1
H2312	810	0	1	01	01	H2312_810_0	7		1	06/02/2014	2015.01	06/02/2014 11:06:42 AM Eastern Daylight Time	07/01/2014 02:37:07 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	HEALTH ALLIANCE PLAN OF MICHIGAN	HAP Senior Plus	www.hap.org	HAP Senior Plus - Group Only non Cal (HMO) (HMO)	01	01		1			H2312	810	0	2015	9 Counties of South East Michigan		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)801-1770		(313)664-7015		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		1	1	011100000100000000110000001100000010	2		1					1
H2318	001	0	1	20	08	H2318_001_0	1		1	05/21/2014	2015.01	05/21/2014 01:15:47 PM Eastern Daylight Time		05/20/2014 05:18:31 PM Eastern Daylight Time			05/21/2014 01:36:57 PM Eastern Daylight Time	CENTER FOR SENIOR INDEPENDENCE	Center for Senior Independence	www.csipace.org	Center for Senior Independence (PACE)	08	20		1			H2318	001	0	2015	Michigan, Wayne County Area		2		1	1		2								Milwaukee.PACE@milliman.com	henryford.com									(855)445-4554		(313)543-6320		(855)445-4554		(313)543-6320										(313)916-2600		(313)876-4756		(313)916-2600		(313)876-4756												
H2318	002	0	1	20	08	H2318_002_0	1		1	05/21/2014	2015.01	05/21/2014 01:16:00 PM Eastern Daylight Time		05/20/2014 05:24:07 PM Eastern Daylight Time			05/21/2014 01:36:57 PM Eastern Daylight Time	CENTER FOR SENIOR INDEPENDENCE	Center for Senior Independence	www.csipace.org	Center for Senior Independence (PACE)	08	20		1			H2318	002	0	2015	Michigan, Wayne County Area		2		1	1		2								Milwaukee.PACE@milliman.com	henryford.com									(855)445-4554		(313)543-6320		(855)445-4554		(313)543-6320										(313)916-2600		(313)876-4756		(313)916-2600		(313)876-4756												
H2320	007	0	1	02	01	H2320_007_0	7		1	07/18/2014	2015.02	07/18/2014 03:50:48 PM Eastern Daylight Time	08/01/2014 05:52:40 PM Eastern Daylight Time	08/01/2014 09:27:30 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	007	0	2015	MI counties: 7 west, 6 mid-MI, 2 north and 1 east		2	3667	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	008	0	1	02	01	H2320_008_0	5		1	07/18/2014	2015.02	07/18/2014 03:55:03 PM Eastern Daylight Time	08/01/2014 05:52:48 PM Eastern Daylight Time	08/01/2014 09:27:38 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	008	0	2015	MI counties: 4 southeast, 9 north and 4 mid-MI		2	1608	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	011	0	1	02	01	H2320_011_0	7		1	07/18/2014	2015.02	07/18/2014 03:59:19 PM Eastern Daylight Time	08/01/2014 05:52:56 PM Eastern Daylight Time	08/01/2014 09:27:46 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	011	0	2015	MI counties: 7 west, 6 mid-MI, 2 north and 1 east		2	7930	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	012	0	1	02	01	H2320_012_0	7		1	07/18/2014	2015.02	07/18/2014 04:01:50 PM Eastern Daylight Time	08/01/2014 05:53:02 PM Eastern Daylight Time	08/01/2014 09:27:56 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	012	0	2015	MI counties: 4 southeast, 9 north and 4 mid-MI		2	3285	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	013	0	1	02	01	H2320_013_0	5		1	07/18/2014	2015.02	07/18/2014 03:55:36 PM Eastern Daylight Time	08/01/2014 05:53:10 PM Eastern Daylight Time	08/01/2014 09:28:04 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	013	0	2015	MI Counties: AG, BR, KN, LN, NW, OW		2	15033	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	015	0	1	02	01	H2320_015_0	6		1	07/18/2014	2015.02	07/18/2014 04:02:10 PM Eastern Daylight Time	08/01/2014 05:53:18 PM Eastern Daylight Time	08/01/2014 09:28:12 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	015	0	2015	MI Counties: AG, BR, KN, LN, NW, OW		2	32657	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	016	0	1	02	01	H2320_016_0	6		1	07/18/2014	2015.02	07/18/2014 03:55:55 PM Eastern Daylight Time	08/01/2014 05:53:26 PM Eastern Daylight Time	08/01/2014 09:28:22 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	016	0	2015	MI counties: 3 SE, 3 SW, 6 NE, 2 NW and 3 mid-MI		2	568	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	018	0	1	02	01	H2320_018_0	6		1	07/18/2014	2015.02	07/18/2014 04:02:25 PM Eastern Daylight Time	08/01/2014 05:53:34 PM Eastern Daylight Time	08/01/2014 09:28:32 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	018	0	2015	MI counties: 3 SE, 3 SW, 6 NE, 2 NW and 3 mid-MI		2	1782	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	019	0	1	02	01	H2320_019_0	5		1	07/18/2014	2015.02	07/18/2014 03:56:20 PM Eastern Daylight Time	08/01/2014 05:53:42 PM Eastern Daylight Time	08/01/2014 09:28:40 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare (HMO-POS)	01	02		1			H2320	019	0	2015	MI counties: 11 east and 1 SW		2	603	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	021	0	1	02	01	H2320_021_0	6		1	07/18/2014	2015.02	07/18/2014 04:02:45 PM Eastern Daylight Time	08/01/2014 05:53:50 PM Eastern Daylight Time	08/01/2014 09:28:48 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Value (HMO-POS)	01	02		1			H2320	021	0	2015	MI counties: 11 east and 1 SW		2	1987	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	802	0	1	02	01	H2320_802_0	4		1	07/18/2014	2015.02	07/18/2014 04:05:33 PM Eastern Daylight Time	07/17/2014 11:47:29 AM Eastern Daylight Time				07/18/2014 04:47:58 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Non-Calendar Year (HMO-POS)	01	02		1			H2320	802	0	2015	National		1	1327	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	803	0	1	02	01	H2320_803_0	4		1	07/18/2014	2015.02	07/18/2014 04:06:57 PM Eastern Daylight Time	07/17/2014 11:47:29 AM Eastern Daylight Time				07/18/2014 04:47:58 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG Calendar Year (HMO-POS)	01	02		1			H2320	803	0	2015	National		1	12664	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	804	0	1	01	01	H2320_804_0	4		1	07/18/2014	2015.02	07/18/2014 04:07:45 PM Eastern Daylight Time	07/17/2014 11:47:29 AM Eastern Daylight Time				07/18/2014 04:47:58 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO w PD Non-Cal Year (HMO)	01	01		1			H2320	804	0	2015	State of Michigan		1	77	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2320	805	0	1	01	01	H2320_805_0	4		1	07/18/2014	2015.02	07/18/2014 04:08:42 PM Eastern Daylight Time	07/17/2014 11:47:29 AM Eastern Daylight Time				07/18/2014 04:47:58 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare EG HMO w PD Cal Year (HMO)	01	01		1			H2320	805	0	2015	State of Michigan		1	4	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2322	004	0	1	04	01	H2322_004_0	9		1	07/23/2014	2015.01	07/23/2014 05:57:36 PM Eastern Daylight Time	08/04/2014 04:00:20 PM Eastern Daylight Time	08/04/2014 06:11:52 PM Eastern Daylight Time			08/06/2014 12:40:18 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO (PPO)	01	04		1			H2322	004	0	2015	Southeastern Michigan (9 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					
H2322	008	0	1	04	01	H2322_008_0	9		1	07/23/2014	2015.01	07/23/2014 05:57:55 PM Eastern Daylight Time	08/04/2014 04:02:45 PM Eastern Daylight Time	08/04/2014 06:11:39 PM Eastern Daylight Time			08/06/2014 12:40:18 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO (PPO)	01	04		1			H2322	008	0	2015	Southeastern Michigan (9 Counties)		2		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					
H2322	801	0	1	04	01	H2322_801_0	8		1	06/02/2014	2015.01	06/02/2014 11:06:59 AM Eastern Daylight Time	07/01/2014 02:30:14 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO - Group Only (PPO)	01	04		1			H2322	801	0	2015	Southeastern Michigan (9 Counties)		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777										1	1	011100000100000000110110001100000100	2		1					
H2322	803	0	1	04	01	H2322_803_0	8		1	06/02/2014	2015.01	06/02/2014 11:07:15 AM Eastern Daylight Time	07/01/2014 02:30:27 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org/Medicare	Alliance Medicare PPO - Group Only (PPO)	01	04		1			H2322	803	0	2015	Southeastern Michigan (9 Counties)		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		1	1	011100000100000000110110001100000100	2		1					
H2322	809	0	1	04	01	H2322_809_0	8		1	06/02/2014	2015.01	06/02/2014 11:30:16 AM Eastern Daylight Time	07/01/2014 02:30:36 PM Eastern Daylight Time				07/01/2014 02:43:19 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare PPO	www.hap.org	Alliance Medicare PPO - Group Only Non Cal (PPO)	01	04		1			H2322	809	0	2015	9 Counties of South East Michigan		1		2			2							www.hap.org	www.hap.org/medicare	www.hap.org/medicare	(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(888)658-2536		(313)664-9050		(800)868-3153		(800)868-3153		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		1	1	011100000100000000110110001100000100	2		1					
H2323	005	0	1	01	01	H2323_005_0	14		1	08/06/2014	2015.01	08/06/2014 10:18:59 AM Central Daylight Time	08/06/2014 10:32:59 AM Central Daylight Time	08/06/2014 10:33:00 AM Central Daylight Time			08/06/2014 12:12:22 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare Of Michigan	www.fidelissc.com	Fidelis Secure Comfort (HMO SNP)	01	01		1			H2323	005	0	2015	Selected Michigan Counties		2	63	2			1	1	1	1				www.fidelissc.com	www.fidelissc.com	www.fidelissc.com	(877)372-8085		(877)372-8085		(855)402-4791		(313)870-9600		(866)832-9245		(866)832-9245		(855)402-4791		(313)870-9600		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2
H2323	011	0	1	01	01	H2323_011_0	13		1	08/06/2014	2015.01	08/06/2014 10:23:31 AM Central Daylight Time	08/06/2014 10:33:01 AM Central Daylight Time	08/06/2014 10:33:02 AM Central Daylight Time			08/06/2014 12:12:22 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare Of Michigan	www.fidelissc.com	Fidelis Secure Freedom (HMO SNP)	01	01		1			H2323	011	0	2015	Selected Michigan Counties		2	115	2			1	1	2	1				www.fidelissc.com	www.fidelissc.com	www.fidelissc.com	(877)372-8085		(877)372-8085		(855)402-4791		(313)870-9600		(866)832-9245		(866)832-9245		(855)402-4791		(313)870-9600		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2
H2323	012	0	1	01	01	H2323_012_0	10	2	1	08/06/2014	2015.01	08/06/2014 10:24:21 AM Central Daylight Time	08/06/2014 10:33:04 AM Central Daylight Time	08/06/2014 10:33:05 AM Central Daylight Time			08/06/2014 12:12:22 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare Of Michigan	www.fidelissc.com	Fidelis Secure Liberty (HMO SNP)	01	01		1			H2323	012	0	2015	Metro Detroit Area		2	1566	2			1	3		1	4			www.fidelissc.com	www.fidelissc.com	www.fidelissc.com	(877)372-8085		(877)372-8085		(855)402-4791		(313)870-9600		(866)832-9245		(866)832-9245		(855)402-4791		(313)870-9600		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2
H2323	015	0	1	01	01	H2323_015_0	8		1	08/06/2014	2015.01	08/06/2014 10:28:14 AM Central Daylight Time	08/06/2014 10:33:06 AM Central Daylight Time	08/06/2014 10:33:07 AM Central Daylight Time			08/06/2014 12:12:22 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare Of Michigan	www.fidelissc.com	Fidelis Secure Respect (HMO)	01	01		1			H2323	015	0	2015	Metro Detroit Area		2	1149	2			2							www.fidelissc.com	www.fidelissc.com	www.fidelissc.com	(877)372-8085		(877)372-8085		(855)402-4791		(313)870-9600		(866)832-9245		(866)832-9245		(855)402-4791		(313)870-9600		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2
H2323	016	0	1	01	01	H2323_016_0	6		1	05/31/2014	2015.01	05/31/2014 12:12:17 AM Central Daylight Time	08/06/2014 10:33:09 AM Central Daylight Time	08/06/2014 10:32:57 AM Central Daylight Time			08/06/2014 12:12:22 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare Of Michigan	www.fidelissc.com	Fidelis Secure Premier (HMO)	01	01		1			H2323	016	0	2015	Metro Detroit Area		2	110	2			2							www.fidelissc.com	www.fidelissc.com	www.fidelissc.com	(877)372-8085		(877)372-8085		(855)402-4791		(313)870-9600		(866)832-9245		(866)832-9245		(855)402-4791		(313)870-9600		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2
H2354	001	0	1	01	01	H2354_001_0	6		1	07/18/2014	2015.01	07/18/2014 11:42:30 AM Eastern Daylight Time	08/06/2014 08:16:43 AM Eastern Daylight Time	08/06/2014 08:16:41 AM Eastern Daylight Time			08/06/2014 09:25:29 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	HealthPlus MedicarePlus Option 1 (HMO)	01	01		1			H2354	001	0	2015	22 Mid-Michigan and Southeast Michigan Counties		2	313	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					2
H2354	013	0	1	01	01	H2354_013_0	8		1	07/18/2014	2015.01	07/18/2014 11:42:36 AM Eastern Daylight Time	08/06/2014 08:16:41 AM Eastern Daylight Time	08/06/2014 08:16:41 AM Eastern Daylight Time			08/06/2014 09:25:29 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	HealthPlus MedicarePlus Option 2 (HMO)	01	01		1			H2354	013	0	2015	22 Mid-Michigan and Southeast Michigan Counties		2	262	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					2
H2354	015	0	1	01	01	H2354_015_0	7		1	08/06/2014	2015.01	08/06/2014 09:13:57 AM Eastern Daylight Time	08/06/2014 08:16:42 AM Eastern Daylight Time	08/06/2014 08:16:42 AM Eastern Daylight Time			08/06/2014 09:25:29 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	HealthPlus MedicarePlus Option 0 (HMO)	01	01		1			H2354	015	0	2015	22 Mid-Michigan and Southeast Michigan Counties		2	274	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					2					2
H2354	016	0	1	01	01	H2354_016_0	6	2	1	09/12/2014	2015.01	09/12/2014 01:23:28 PM Eastern Daylight Time	08/06/2014 08:16:42 AM Eastern Daylight Time	08/06/2014 08:16:42 AM Eastern Daylight Time			09/12/2014 03:45:32 PM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	HealthPlus MedicarePlus Advantage D-SNP (HMO SNP)	01	01		1			H2354	016	0	2015	6 Mid-Michigan and Southeast Michigan Counties		2		2			1	3		1	5			www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					1					1
H2354	801	0	1	01	01	H2354_801_0	3		1	05/08/2014	2015.01	05/08/2014 01:45:25 PM Eastern Daylight Time	07/21/2014 09:57:34 AM Eastern Daylight Time				07/21/2014 10:04:37 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	Emp-only - HealthPlus MA-only (HMO)	01	01		1			H2354	801	0	2015	United States EG Area		1		2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161										(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070										1	1	000000000101011110000000000000000000	2		1					1
H2354	802	0	1	02	01	H2354_802_0	4		1	07/10/2014	2015.01	07/10/2014 02:16:19 PM Eastern Daylight Time	07/21/2014 08:54:08 AM Eastern Daylight Time				07/21/2014 10:04:37 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	Emp-only - HealthPlus MA-PD calendar yr. (HMO-POS)	01	02		1			H2354	802	0	2015	United States EG Area		1	313	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					1	2		2		1
H2354	805	0	1	02	01	H2354_805_0	4		1	07/10/2014	2015.01	07/10/2014 02:16:25 PM Eastern Daylight Time	07/21/2014 08:54:12 AM Eastern Daylight Time				07/21/2014 10:04:37 AM Eastern Daylight Time	HEALTHPLUS OF MICHIGAN	HealthPlus of Michigan	www.healthplus.org	Emp-only - HealthPlus MA-PD non-calendar yr. (HMO-POS)	01	02		1			H2354	805	0	2015	United States EG Area		1	313	2			2							www.healthplus.org	www.healthplus.org/partdformularies.aspx	www.healthplus.org	(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)332-9161		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		(800)992-5070		2					1	2		2		1
H2386	001	0	1	20	08	H2386_001_0	1		1	05/20/2014	2015.01	05/20/2014 01:20:56 PM Eastern Daylight Time		05/16/2014 06:24:17 PM Eastern Daylight Time			05/20/2014 01:23:27 PM Eastern Daylight Time	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	Appalachian Agency for Senior Citizens, Inc,	www.aasc.org	AllCARE for Seniors - Duals (PACE)	08	20		1			H2386	001	0	2015	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2								www.aasc.org	www.seniorscript.com									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152											
H2386	002	0	1	20	08	H2386_002_0	1		1	05/20/2014	2015.01	05/20/2014 01:21:25 PM Eastern Daylight Time		05/16/2014 06:49:34 PM Eastern Daylight Time			05/20/2014 01:23:27 PM Eastern Daylight Time	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	Appalachian Agency for Senior Citizens, Inc,	www.aasc.org	AllCARE for Seniors - Medicare only (PACE)	08	20		1			H2386	002	0	2015	Counties:  Buchanan, Dickenson, Russell, Tazewell		2		2			2								www.aasc.org	www.seniorscript.com									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152									(800)656-2272	7152	(276)964-4915	7152	(800)656-2272	7152	(276)964-4915	7152											
H2406	001	0	1	04	01	H2406_001_0	6		1	07/18/2014	2015.02	07/18/2014 09:26:11 AM Central Daylight Time	08/04/2014 05:40:34 PM Central Daylight Time	07/31/2014 03:20:27 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H2406	001	0	2015	Select Counties in Ohio		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2411	803	0	1	04	01	H2411_803_0	5		1	07/30/2014	2015.02	07/30/2014 03:01:51 PM Eastern Daylight Time	07/30/2014 01:28:49 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	MA-PD PPO (PPO)	01	04		1			H2411	803	0	2015	Full Service Area - Employer Groups		1	32	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011111000100	1	111111111011010111110000000	1					
H2416	001	0	1	01	01	H2416_001_0	3	2	1	06/02/2014	2015.01	06/02/2014 09:04:32 AM Central Daylight Time	08/05/2014 09:24:49 AM Central Daylight Time	08/05/2014 09:25:44 AM Central Daylight Time			08/06/2014 10:43:53 AM Central Daylight Time	PRIMEWEST CTRL COUNTY-BASED PURCHASING INITIATIVE	PrimeWest Health	www.primewest.org/Members/PWSHC_HMO.aspx	PrimeWest Senior Health Complete (HMO SNP)	01	01		1			H2416	001	0	2015	Northern, west central, and southwestern Minnesota		2	2582	2			1	3		1	5			www.primewest.org/FindA/Default.aspx	http://www.primewest.org/FindA/Drug.aspx	http://www.primewest.org/FindA/Pharmacy.aspx	(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)366-2906		(320)335-5243		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	011100010100000001111111011100000000	2		1					1
H2417	001	0	1	01	01	H2417_001_0	2	2	1	06/02/2014	2015.01	06/02/2014 09:03:20 AM Central Daylight Time	08/05/2014 09:33:31 AM Central Daylight Time	08/05/2014 09:34:02 AM Central Daylight Time			08/06/2014 10:20:48 AM Central Daylight Time	ITASCA MEDICAL CARE	Itasca Medical Care/IMCare Classic	www.imcare.org	IMCare Classic (HMO SNP)	01	01		1			H2417	001	0	2015	Itasca County		2	571	2			1	3		1	5			http://www.imcare.org	http://www.imcare.org	http://www.caremark.com/wps/portal	(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)843-9536		(218)327-6188		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	011111111011111110000011111111000001	1	101111011111110000011110000	1					1
H2419	001	0	1	01	01	H2419_001_0	3	2	1	07/16/2014	2015.01	07/16/2014 04:36:52 PM Central Daylight Time	08/04/2014 09:58:21 AM Central Daylight Time	08/04/2014 09:41:22 AM Central Daylight Time			08/04/2014 06:23:55 PM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	SeniorCare Complete (HMO SNP)	01	01		1			H2419	001	0	2015	Select Counties in Minnesota		2	2217	1	1		1	3		1	5			www.mnscha.org	www.mnscha.org	www.mnscha.org	(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2422	002	0	1	01	01	H2422_002_0	8	2	1	08/04/2014	2015.01	08/04/2014 05:36:47 PM Central Daylight Time	08/05/2014 08:39:08 AM Central Daylight Time	07/31/2014 01:54:40 PM Central Daylight Time			08/05/2014 12:20:28 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners	healthpartners.com/msho	HealthPartners Minnesota Senior Health Options (HMO SNP)	01	01		1			H2422	002	0	2015	Minneapolis/St. Paul Metro Area		2		2			1	3		1	5			healthpartners.com/msho	healthpartners.com/medicarerx	healthpartners.com/msho	(888)820-4285		(952)967-7029		(877)713-8215		(952)883-5050		(888)820-4285		(952)967-7029		(877)713-8215		(952)883-5050		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2
H2425	001	0	1	01	01	H2425_001_0	10	2	1	07/15/2014	2015.01	07/15/2014 09:25:05 AM Central Daylight Time	08/04/2014 08:03:50 AM Central Daylight Time	07/31/2014 03:09:50 PM Central Daylight Time			08/04/2014 12:35:05 PM Central Daylight Time	BLUE PLUS	Blue Plus	www.bluecrossmn.com/secureblue	SecureBlue (HMO SNP)	01	01		1			H2425	001	0	2015	87 Counties within the State of Minnesota		2	7957	2			1	3		1	5			www.bluecrossmn.com/secureblue	www.myprime.com	www.myprime.com	(888)740-6013		(651)662-6013		(866)477-1584		(651)662-3584		(888)740-6013		(651)662-6013		(866)477-1584		(651)662-3584		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					2
H2450	001	0	1	18	06	H2450_001_0	4		1	07/11/2014	2015.01	07/11/2014 11:03:13 AM Central Daylight Time		08/04/2014 02:17:56 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Basic with Part D Option 2 (Cost)	06	18		1			H2450	001	0	2015	All of MN, plus select counties in ND, SD and WI		2	240387	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	002	0	1	18	06	H2450_002_0	4		1	07/11/2014	2015.01	07/11/2014 02:36:19 PM Central Daylight Time		08/04/2014 02:18:48 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Enhanced w/Part D Option 2 (Cost)	06	18		1			H2450	002	0	2015	All of MN, plus select counties in ND, SD and WI		2	308191	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	007	0	1	18	06	H2450_007_0	4		1	07/11/2014	2015.01	07/11/2014 11:04:31 AM Central Daylight Time		08/04/2014 02:19:57 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Thrift with Part D Option 1 (Cost)	06	18		1			H2450	007	0	2015	All of MN, plus select counties in ND, SD and WI		2	11472	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	016	0	1	18	06	H2450_016_0	4		1	07/11/2014	2015.01	07/11/2014 11:05:51 AM Central Daylight Time		08/04/2014 02:20:49 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Basic with Part D Option 1 (Cost)	06	18		1			H2450	016	0	2015	All of MN, plus select counties in ND, SD and WI		2	190029	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	017	0	1	18	06	H2450_017_0	4		1	07/11/2014	2015.01	07/11/2014 11:07:33 AM Central Daylight Time		08/04/2014 02:21:40 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Enhanced w/Part D Option 1 (Cost)	06	18		1			H2450	017	0	2015	All of MN, plus select counties in ND, SD and WI		2	105585	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	022	0	1	18	06	H2450_022_0	4		1	07/11/2014	2015.01	07/11/2014 11:08:02 AM Central Daylight Time		08/04/2014 02:23:19 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Value with Part D Option 1 (Cost)	06	18		1			H2450	022	0	2015	All of MN, plus select counties in ND, SD and WI		2	60392	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	023	0	1	18	06	H2450_023_0	4		1	07/11/2014	2015.01	07/11/2014 11:08:30 AM Central Daylight Time		08/04/2014 02:24:23 PM Central Daylight Time			08/05/2014 08:44:16 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Prime Solution Value with Part D Option 2 (Cost)	06	18		1			H2450	023	0	2015	All of MN, plus select counties in ND, SD and WI		2	31498	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)234-8755		(952)992-2300		(800)906-5432		(952)992-2345		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2450	801	0	1	18	06	H2450_801_0	2		1	05/07/2014	2015.01	05/07/2014 10:34:58 AM Central Daylight Time					05/31/2014 10:07:55 AM Central Daylight Time	MEDICA INSURANCE COMPANY	Medica Insurance Company	www.medica.com	Medica Grp Prime Solution Calendar w/5-tier Part D (Cost)	06	18		1			H2450	801	0	2015	All of MN, plus select Counties in ND , SD and WI		1	91296	2			2							www.medica.com/Member	www.medica.com/Member	www.medica.com/Member	(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)575-2330		(952)992-2330		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880												
H2456	002	0	1	01	01	H2456_002_0	9	2	1	07/25/2014	2015.01	07/25/2014 04:01:23 PM Central Daylight Time	08/01/2014 10:02:35 AM Central Daylight Time	08/01/2014 10:04:52 AM Central Daylight Time			08/06/2014 04:46:03 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare's Minnesota Senior Health Options (HMO SNP)	01	01		1			H2456	002	0	2015	Twin Cities Metropolitan area and Greater MN		2		2			1	3		1	5			www.ucare.org	www.ucare.org	www.ucare.org	(866)280-7202		(612)676-6868		(800)707-1711		(612)676-3554		(866)280-7202		(612)676-6868		(800)707-1711		(612)676-3554		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2
H2458	002	0	1	01	01	H2458_002_0	8	2	1	08/06/2014	2015.01	08/06/2014 03:57:06 PM Central Daylight Time	08/06/2014 02:11:01 PM Central Daylight Time	08/06/2014 02:10:55 PM Central Daylight Time			08/06/2014 04:04:53 PM Central Daylight Time	MEDICA HEALTH PLANS	Medica Health Plans	www.medica.com	Medica DUAL Solution (HMO SNP)	01	01		1			H2458	002	0	2015	Specific Minnesota Counties		2	118894	2			1	3		1	5			www.medica.com/Medicare	www.medica.com/Member	https://www.medica.com/pharmacy/medicaid/medica-dual-solution	(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(888)347-3630		(952)992-2580		(800)266-2157		(952)992-2030		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H2459	001	0	1	02	01	H2459_001_0	9		1	07/24/2014	2015.01	07/24/2014 01:49:36 PM Central Daylight Time	06/04/2014 12:58:02 PM Central Daylight Time				07/25/2014 04:05:47 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Value (HMO-POS)	01	02		1			H2459	001	0	2015	Minnesota		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500										(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810										2					2					2
H2459	002	0	1	02	01	H2459_002_0	7		1	07/25/2014	2015.01	07/25/2014 03:21:37 PM Central Daylight Time	08/01/2014 10:03:50 AM Central Daylight Time	08/01/2014 10:05:24 AM Central Daylight Time			08/06/2014 04:46:03 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Classic (HMO-POS)	01	02		1			H2459	002	0	2015	44 Counties		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2
H2459	013	0	1	02	01	H2459_013_0	7		1	07/25/2014	2015.01	07/25/2014 03:20:42 PM Central Daylight Time	08/01/2014 10:06:01 AM Central Daylight Time	08/01/2014 10:06:33 AM Central Daylight Time			08/06/2014 04:46:03 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Value Plus (HMO-POS)	01	02		1			H2459	013	0	2015	44 Counties		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2
H2459	019	0	1	02	01	H2459_019_0	7		1	07/24/2014	2015.01	07/24/2014 01:50:59 PM Central Daylight Time	08/01/2014 10:07:11 AM Central Daylight Time	08/01/2014 10:07:51 AM Central Daylight Time			08/06/2014 04:46:03 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	UCare for Seniors Essentials Rx (HMO-POS)	01	02		1			H2459	019	0	2015	Minnesota		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2
H2459	801	0	1	02	01	H2459_801_0	4		1	06/02/2014	2015.01	06/02/2014 04:41:31 PM Central Daylight Time	06/02/2014 09:50:01 PM Central Daylight Time				06/02/2014 10:25:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	Group UCare for Seniors (HMO-POS)	01	02		1			H2459	801	0	2015	Minnesota and 26 Wisconsin Counties		1		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900		(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		1	2		2		1	2		2		1
H2459	805	0	1	02	01	H2459_805_0	2		1	05/29/2014	2015.01	05/29/2014 01:14:24 PM Central Daylight Time	06/02/2014 09:50:55 PM Central Daylight Time				06/02/2014 10:25:53 PM Central Daylight Time	UCARE MINNESOTA	UCare	www.ucare.org	Group UCare for Seniors (HMO-POS)	01	02		1			H2459	805	0	2015	Minnesota and 26 Wisconsin Counties		1		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900										(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810										1	2		2		1	2		2		1
H2461	005	0	1	18	06	H2461_005_0	5		1	07/21/2014	2015.01	07/21/2014 12:17:32 PM Central Daylight Time					07/21/2014 09:30:38 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Core Plan (Cost)	06	18		1			H2461	005	0	2015	State of Minnesota		2	2987	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2
H2461	006	0	1	18	06	H2461_006_0	4		1	07/15/2014	2015.01	07/15/2014 09:31:09 AM Central Daylight Time					07/15/2014 09:45:58 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Choice Plan (Cost)	06	18		1			H2461	006	0	2015	State of Minnesota		2	29616	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2
H2461	007	0	1	18	06	H2461_007_0	4		1	07/15/2014	2015.01	07/15/2014 09:30:56 AM Central Daylight Time					07/15/2014 09:45:58 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Complete Plan (Cost)	06	18		1			H2461	007	0	2015	State of Minnesota		2	87407	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583										(711)-		(711)-		(711)-		(711)-										2					2					2
H2461	008	0	1	18	06	H2461_008_0	4		1	07/21/2014	2015.01	07/21/2014 12:16:26 PM Central Daylight Time		07/31/2014 03:23:30 PM Central Daylight Time			08/05/2014 08:13:27 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Core Plan with Rx (Cost)	06	18		1			H2461	008	0	2015	State of Minnesota		2	1711	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2461	009	0	1	18	06	H2461_009_0	4		1	07/15/2014	2015.01	07/15/2014 09:32:35 AM Central Daylight Time		07/31/2014 03:18:32 PM Central Daylight Time			08/05/2014 08:13:27 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Choice Plan with Rx (Cost)	06	18		1			H2461	009	0	2015	State of Minnesota		2	12775	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2461	010	0	1	18	06	H2461_010_0	4		1	07/15/2014	2015.01	07/15/2014 09:32:55 AM Central Daylight Time		07/31/2014 03:19:38 PM Central Daylight Time			08/05/2014 08:13:27 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD OF MINNESOTA	Blue Cross and Blue Shield of Minnesota	www.bluecrossmn.com	Platinum Blue Complete Plan with Rx (Cost)	06	18		1			H2461	010	0	2015	State of Minnesota		2	37430	2			2								www.bluecrossmn.com	www.primetherapeutics.com	(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(866)340-8654		(651)662-5654		(877)662-2583		(651)662-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2462	004	0	1	18	06	H2462_004_0	2		1	05/30/2014	2015.01	05/30/2014 10:06:42 AM Central Daylight Time					05/30/2014 10:09:49 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Basic (Cost)	06	18		1			H2462	004	0	2015	State of Minnesota		2	61	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2
H2462	007	0	1	18	06	H2462_007_0	4		1	07/03/2014	2015.01	07/03/2014 01:44:23 PM Central Daylight Time					07/09/2014 10:07:32 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance (Cost)	06	18		1			H2462	007	0	2015	State of Minnesota		2	804	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2
H2462	008	0	1	18	06	H2462_008_0	8		1	08/04/2014	2015.01	08/04/2014 09:39:05 AM Central Daylight Time		07/31/2014 02:42:18 PM Central Daylight Time			08/04/2014 09:40:26 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Balance with Rx (Cost)	06	18		1			H2462	008	0	2015	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2
H2462	010	0	1	18	06	H2462_010_0	3		1	07/03/2014	2015.01	07/03/2014 01:48:05 PM Central Daylight Time					07/09/2014 10:12:58 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate (Cost)	06	18		1			H2462	010	0	2015	State of Minnesota		2	1400	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2
H2462	011	0	1	18	06	H2462_011_0	5		1	07/03/2014	2015.01	07/03/2014 01:49:20 PM Central Daylight Time		07/31/2014 01:57:52 PM Central Daylight Time			08/04/2014 09:44:46 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate with Rx (Cost)	06	18		1			H2462	011	0	2015	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2
H2462	012	0	1	18	06	H2462_012_0	5		1	07/03/2014	2015.01	07/03/2014 01:50:09 PM Central Daylight Time		07/31/2014 02:05:10 PM Central Daylight Time			08/04/2014 09:50:29 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Ultimate with Enhanced Rx (Cost)	06	18		1			H2462	012	0	2015	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2
H2462	015	0	1	18	06	H2462_015_0	2		1	05/30/2014	2015.01	05/30/2014 10:03:42 AM Central Daylight Time					05/30/2014 10:28:35 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Wisconsin Freedom Basic (Cost)	06	18		1			H2462	015	0	2015	Western Wisconsin		2	2	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2
H2462	016	0	1	18	06	H2462_016_0	2		1	05/30/2014	2015.01	05/30/2014 10:03:52 AM Central Daylight Time					05/30/2014 10:34:38 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Wisconsin Freedom Balance (Cost)	06	18		1			H2462	016	0	2015	Western Wisconsin		2	15	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2
H2462	017	0	1	18	06	H2462_017_0	3		1	05/30/2014	2015.01	05/30/2014 10:38:48 AM Central Daylight Time		07/31/2014 02:07:56 PM Central Daylight Time			08/04/2014 09:53:07 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Wisconsin Freedom Balance with Rx (Cost)	06	18		1			H2462	017	0	2015	Western Wisconsin		2	51	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2
H2462	018	0	1	18	06	H2462_018_0	3		1	07/03/2014	2015.01	07/03/2014 02:51:03 PM Central Daylight Time					07/09/2014 10:20:14 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital (Cost)	06	18		1			H2462	018	0	2015	State of Minnesota		2	713	2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060										2					2					2
H2462	019	0	1	18	06	H2462_019_0	5		1	07/03/2014	2015.01	07/03/2014 01:51:57 PM Central Daylight Time		07/31/2014 02:20:02 PM Central Daylight Time			08/04/2014 09:55:58 AM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Vital with Rx (Cost)	06	18		1			H2462	019	0	2015	State of Minnesota		2		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)233-9645		(952)883-7979		(800)247-7015		(952)883-5601		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		2					2					2
H2462	801	0	1	18	06	H2462_801_0	1		1	05/01/2014	2015.01	05/01/2014 01:17:27 PM Central Daylight Time					05/23/2014 03:52:56 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Calendar Year (Cost)	06	18		1			H2462	801	0	2015	State of MN Western Wisconsin		1		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060												
H2462	802	0	1	18	06	H2462_802_0	1		1	05/01/2014	2015.01	05/01/2014 01:17:40 PM Central Daylight Time					05/23/2014 03:55:13 PM Central Daylight Time	GROUP HEALTH PLAN, INC. (MN)	HealthPartners	healthpartners.com/medicare	HealthPartners Freedom Non-Calendar Year (Cost)	06	18		1			H2462	802	0	2015	State of MN Western Wisconsin		1		2			2								healthpartners.com/medicarerx	healthpartners.com/medicare	(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)233-9645		(952)883-7979		(866)993-7428		(952)883-7428		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060												
H2470	001	0	1	01	01	H2470_001_0	10	2	1	08/07/2014	2015.02	08/07/2014 10:52:20 AM Eastern Daylight Time	08/06/2014 04:20:39 PM Eastern Daylight Time	08/07/2014 11:01:23 AM Eastern Daylight Time			08/07/2014 11:24:00 AM Eastern Daylight Time	TOTAL AGING IN PLACE PROGRAM, INC.	Total Aging in Place Program, Inc	www.fallonweinberg.org	Fallon Health Weinberg (HMO SNP)	01	01		1			H2470	001	0	2015	Erie and Niagara Counties		2	544	2			1	3		1	4			www.fallonweinberg.org	www.fallonweinberg.org	www.fallonweinberg.org	(855)561-7247		(855)561-7247		(855)561-7248		(855)561-7248		(855)561-7247		(855)561-7247		(855)561-7248		(855)561-7248		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2486	003	0	1	01	01	H2486_003_0	3		1	08/04/2014	2015.02	08/04/2014 12:29:29 PM Eastern Daylight Time	08/05/2014 02:19:57 PM Eastern Daylight Time	08/04/2014 05:04:11 PM Eastern Daylight Time			08/06/2014 08:00:10 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana Medical Plan of Utah, Inc.	www.humana-medicare.com	Humana Gold Plus H2486-003 (HMO)	01	01		1			H2486	003	0	2015	Davis, Salt Lake, Utah and Weber counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2486	801	0	1	01	01	H2486_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:35:35 PM Eastern Daylight Time	07/14/2014 10:43:16 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana Medical Plan of Utah, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2486	801	0	2015	Select counties in Utah		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2486	802	0	1	01	01	H2486_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:36:19 PM Eastern Daylight Time	07/14/2014 10:53:02 AM Eastern Daylight Time				07/14/2014 01:46:00 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF UTAH, INC.	Humana Medical Plan of Utah, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2486	802	0	2015	Select counties in Utah		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2491	002	0	1	02	01	H2491_002_0	7		1	08/04/2014	2015.02	08/04/2014 01:27:40 PM Eastern Daylight Time	08/05/2014 11:26:39 AM Eastern Daylight Time	08/01/2014 11:31:03 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	'Ohana Health Plan	www.ohanahealthplan.com	'Ohana Value (HMO-POS)	01	02		1			H2491	002	0	2015	Honolulu County		2	1824	2			2							www.ohanahealthplan.com	www.ohanahealthplan.com	www.ohanahealthplan.com	(888)505-1201		(888)505-1201		(877)231-2632		(877)231-2632		(888)505-1201		(888)505-1201		(877)231-2632		(877)231-2632		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H2491	004	0	1	02	01	H2491_004_0	7	2	1	07/23/2014	2015.02	07/23/2014 09:59:10 AM Eastern Daylight Time	08/05/2014 11:26:52 AM Eastern Daylight Time	08/01/2014 11:31:13 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	'Ohana Health Plan	www.ohanahealthplan.com	'Ohana Liberty (HMO-POS SNP)	01	02		1			H2491	004	0	2015	Hawaii, Honolulu, Kauai, Maui Counties		2	7456	2			1	3		1	5			www.ohanahealthplan.com	www.ohanahealthplan.com	www.ohanahealthplan.com	(877)457-7621		(877)457-7621		(877)231-2632		(877)231-2632		(877)457-7621		(877)457-7621		(877)231-2632		(877)231-2632		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H2491	005	0	1	02	01	H2491_005_0	7		1	08/04/2014	2015.02	08/04/2014 01:28:07 PM Eastern Daylight Time	08/05/2014 11:27:06 AM Eastern Daylight Time	08/01/2014 11:31:23 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	'Ohana Health Plan	www.ohanahealthplan.com	'Ohana Choice (HMO-POS)	01	02		1			H2491	005	0	2015	Hawaii, Kauai, Maui		2	68	2			2							www.ohanahealthplan.com	www.ohanahealthplan.com	www.ohanahealthplan.com	(888)505-1201		(888)505-1201		(877)231-2632		(877)231-2632		(888)505-1201		(888)505-1201		(877)231-2632		(877)231-2632		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H2506	001	0	1	48	05	H2506_001_0	2		1	06/24/2014	2015.01	06/24/2014 12:19:42 PM Mountain Daylight Time					06/24/2014 02:41:27 PM Mountain Daylight Time	AETNA BETTER HEALTH, INC. (IL)	Aetna Better Health Premier Plan	www.Aetnabetterhealth.com/Illinois	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	05	48		1			H2506	001	0	2015	Illinois		2		2			2							www.Aetnabetterhealth.com/Illinois	http://www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	http://www.aetna.com/pharmacy-insurance/individuals-families/index.html	(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(866)600-2139		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2531	001	0	1	48	05	H2531_001_0	5		1	08/06/2014	2015.01	08/06/2014 12:31:34 PM US Mountain Standard Time					08/06/2014 12:43:43 PM US Mountain Standard Time	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	UnitedHealthcare Community Plan	www.uhccommunityplan.com	UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan)	05	48		1			H2531	001	0	2015	UnitedHealthcare Community Plan MMP Plan Regions		2		2			2							www.uhccommunityplan.com	www.uhccommunityplan.com	www.optumrx.com	(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(877)542-9236		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2533	001	0	1	48	05	H2533_001_0	3		1	09/11/2014	2015.01	09/11/2014 03:29:29 PM Pacific Daylight Time					09/11/2014 03:30:33 PM Pacific Daylight Time	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Molina Healthcare of South Carolina	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H2533	001	0	2015	South Carolina Statewide		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5831		(855)735-5831		(855)701-4885		(855)701-4885		(855)735-5831		(855)735-5831		(855)735-5831		(855)735-5831		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2537	001	0	1	20	08	H2537_001_0	1		1	05/28/2014	2015.01	05/28/2014 09:02:39 AM Eastern Daylight Time		05/27/2014 07:27:35 PM Eastern Daylight Time			05/28/2014 09:14:47 AM Eastern Daylight Time	LIFE LUTHERAN SERVICES, INC.	LIFE Lutheran Services, Inc.	www.lifelutheranservices.org	LIFE Lutheran - Dual (PACE)	08	20		1			H2537	001	0	2015	Franklin, Cumberland Counties		2		2			2								www.lifelutheranservices.org	www.norlandavenuepharmacy.com									(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433												
H2537	002	0	1	20	08	H2537_002_0	1		1	05/28/2014	2015.01	05/28/2014 09:02:56 AM Eastern Daylight Time		05/27/2014 07:27:35 PM Eastern Daylight Time			05/28/2014 09:14:47 AM Eastern Daylight Time	LIFE LUTHERAN SERVICES, INC.	LIFE Lutheran Services, Inc.	www.lifelutheranservices.org	LIFE Lutheran - Medicare Only (PACE)	08	20		1			H2537	002	0	2015	Franklin, Cumberland Counties		2		2			2								www.lifelutheranservices.org	www.norlandavenuepharmacy.com									(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433										(800)840-9081		(717)264-5433		(800)840-9081		(717)264-5433												
H2563	001	0	1	01	01	H2563_001_0	9		1	08/05/2014	2015.01	08/05/2014 03:49:30 PM Eastern Daylight Time	08/05/2014 04:00:30 PM Eastern Daylight Time	08/05/2014 04:04:19 PM Eastern Daylight Time			08/06/2014 11:50:28 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Health Plan	www.optimahealth.com/medicare	Optima Medicare Basic (HMO)	01	01		1			H2563	001	0	2015	Tidewater Virginia		2		2			2							http://optimahealth.prismisp.com/	www.optimahealth.com/medicare	www.optimahealth.com	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		2					2					2
H2563	002	0	1	01	01	H2563_002_0	9		1	08/05/2014	2015.01	08/05/2014 03:49:05 PM Eastern Daylight Time	08/05/2014 03:58:46 PM Eastern Daylight Time	08/05/2014 04:03:32 PM Eastern Daylight Time			08/06/2014 11:50:28 AM Eastern Daylight Time	OPTIMA HEALTH PLAN	Optima Health Plan	www.optimahealth.com/medicare	Optima Medicare Enhanced (HMO)	01	01		1			H2563	002	0	2015	Tidewater Virginia		2		2			2							http://optimahealth.prismisp.com/	www.optimahealth.com/medicare	www.optimahealth.com	(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)927-6048		(757)687-6160		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120		2					2					2
H2591	001	0	1	04	01	H2591_001_0	3		1	08/06/2014	2015.01	08/06/2014 09:08:46 AM Central Daylight Time	08/05/2014 06:14:23 PM Central Daylight Time	07/31/2014 04:50:29 PM Central Daylight Time			08/06/2014 01:26:00 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare Guide PPO Rx (PPO)	01	04		1			H2591	001	0	2015	Nebraska/Iowa		2	989	2			2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		2					2					
H2591	801	0	1	04	01	H2591_801_0	1		1	05/28/2014	2015.01	05/28/2014 04:14:09 PM Central Daylight Time	05/31/2014 09:23:43 PM Central Daylight Time				06/01/2014 07:33:40 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	801	0	2015	Health Alliance Medicare		1	1	1	1		2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454										(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352										1	2		2		1					
H2591	802	0	1	04	01	H2591_802_0	1		1	05/28/2014	2015.01	05/28/2014 04:14:12 PM Central Daylight Time	05/31/2014 09:24:13 PM Central Daylight Time				06/01/2014 07:33:40 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (PPO)	01	04		1			H2591	802	0	2015	Health Alliance Medicare		1	1	1	1		2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1					
H2591	803	0	1	04	01	H2591_803_0	1		1	05/28/2014	2015.01	05/28/2014 04:14:17 PM Central Daylight Time	05/31/2014 09:24:44 PM Central Daylight Time				06/01/2014 07:33:40 PM Central Daylight Time	HEALTH ALLIANCE - MIDWEST, INC.	Health Alliance Medicare	healthalliancemedicare.org	Health Alliance Medicare (non calendar) (PPO)	01	04		1			H2591	803	0	2015	Health Alliance Medicare  (non calendar)		1	1	1	1		2							HealthAllianceMedicare.org	HealthAllianceMedicare.org	HealthAllianceMedicare.org	(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(877)917-8550		(877)917-8550		(877)933-8454		(877)933-8454		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		(800)833-7352		1	2		2		1					
H2593	001	0	1	01	01	H2593_001_0	8		1	08/04/2014	2015.01	08/04/2014 01:47:25 PM Pacific Daylight Time	08/04/2014 11:51:28 AM Pacific Daylight Time	08/01/2014 02:42:52 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H2593	001	0	2015	Pima County		2	5144	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	003	0	1	01	01	H2593_003_0	6		1	07/23/2014	2015.01	07/23/2014 04:34:03 PM Pacific Daylight Time	08/04/2014 11:52:00 AM Pacific Daylight Time	08/01/2014 02:43:04 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Touch (HMO SNP)	01	01		1			H2593	003	0	2015	Pima County		2	893	2			1	1	3	1				www.caremore.com	www.caremore.com	www.caremore.com	(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(800)589-3147		(800)589-3147		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	005	0	1	01	01	H2593_005_0	6		1	07/23/2014	2015.01	07/23/2014 04:52:02 PM Pacific Daylight Time	08/04/2014 11:52:30 AM Pacific Daylight Time	08/01/2014 02:43:16 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H2593	005	0	2015	Pima County		2	810	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	006	0	1	01	01	H2593_006_0	6		1	07/23/2014	2015.01	07/23/2014 04:52:29 PM Pacific Daylight Time	08/04/2014 11:52:15 AM Pacific Daylight Time	08/01/2014 02:43:28 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H2593	006	0	2015	Pima County		2	2583	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	007	0	1	01	01	H2593_007_0	9		1	07/23/2014	2015.01	07/23/2014 04:52:53 PM Pacific Daylight Time	08/04/2014 11:54:23 AM Pacific Daylight Time	08/01/2014 02:43:42 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H2593	007	0	2015	Maricopa County (partial)		2	1456	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	011	0	1	01	01	H2593_011_0	6		1	08/04/2014	2015.01	08/04/2014 01:48:00 PM Pacific Daylight Time	08/04/2014 11:54:53 AM Pacific Daylight Time	08/01/2014 02:43:53 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H2593	011	0	2015	Maricopa County (partial)		2	1263	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	013	0	1	01	01	H2593_013_0	6		1	07/23/2014	2015.01	07/23/2014 05:54:15 PM Pacific Daylight Time	08/04/2014 11:52:47 AM Pacific Daylight Time	08/01/2014 02:44:05 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Heart (HMO SNP)	01	01		1			H2593	013	0	2015	Pima County		2	797	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	014	0	1	01	01	H2593_014_0	6		1	08/04/2014	2015.01	08/04/2014 01:49:08 PM Pacific Daylight Time	08/04/2014 11:55:25 AM Pacific Daylight Time	08/01/2014 02:44:15 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore Heart (HMO SNP)	01	01		1			H2593	014	0	2015	Maricopa County (partial)		2	354	2			1	4		1		00000000000000010000		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	015	0	1	01	01	H2593_015_0	6		1	08/04/2014	2015.01	08/04/2014 01:48:32 PM Pacific Daylight Time	08/04/2014 11:55:09 AM Pacific Daylight Time	08/01/2014 02:44:26 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H2593	015	0	2015	Maricopa County (partial)		2	251	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	016	0	1	01	01	H2593_016_0	6		1	07/23/2014	2015.01	07/23/2014 05:55:52 PM Pacific Daylight Time	08/04/2014 11:54:38 AM Pacific Daylight Time	08/01/2014 02:44:39 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H2593	016	0	2015	Maricopa County (partial)		2	639	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	018	0	1	01	01	H2593_018_0	6		1	07/23/2014	2015.01	07/23/2014 05:56:30 PM Pacific Daylight Time	08/04/2014 11:51:44 AM Pacific Daylight Time	08/01/2014 02:44:51 PM Pacific Daylight Time			08/05/2014 12:10:24 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H2593	018	0	2015	Pima County		2	710	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2593	801	0	1	01	01	H2593_801_0	3		1	05/19/2014	2015.01	05/19/2014 12:06:25 PM Pacific Daylight Time	06/10/2014 11:39:27 AM Pacific Daylight Time				06/10/2014 04:33:00 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore EGWP (HMO)	01	01		1			H2593	801	0	2015	Arizona		1	29	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(855)295-7811		(855)295-7811		(866)622-2820		(866)622-2820										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H2593	802	0	1	01	01	H2593_802_0	3		1	05/19/2014	2015.01	05/19/2014 12:08:27 PM Pacific Daylight Time	06/10/2014 11:38:57 AM Pacific Daylight Time				06/10/2014 04:33:00 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H2593	802	0	2015	Arizona		1	29	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H2593	804	0	1	01	01	H2593_804_0	3		1	05/19/2014	2015.01	05/19/2014 01:52:18 PM Pacific Daylight Time	06/10/2014 11:39:56 AM Pacific Daylight Time				06/10/2014 04:33:00 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF ARIZONA, INC.	CareMore Health Plan of Arizona, Inc.	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H2593	804	0	2015	Arizona		1	10	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H2609	001	0	1	20	08	H2609_001_0	1		1	05/23/2014	2015.01	05/23/2014 09:20:36 AM Central Daylight Time		05/21/2014 09:30:21 AM Central Daylight Time			05/23/2014 09:23:31 AM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianbrothers.net	Dual Eligibles (PACE)	08	20		1			H2609	001	0	2015	St. Louis City and St. Louis County		2		2			2								None	None									(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800										(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800												
H2609	002	0	1	20	08	H2609_002_0	1		1	05/23/2014	2015.01	05/23/2014 09:21:22 AM Central Daylight Time		05/21/2014 09:36:57 AM Central Daylight Time			05/23/2014 09:23:31 AM Central Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	www.alexianbrothers.net	Medicare Only (PACE)	08	20		1			H2609	002	0	2015	St. Louis City and St. Louis County		2		2			2								None	None									(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800										(314)771-5800		(314)771-5800		(314)771-5800		(314)771-5800												
H2610	005	0	1	01	01	H2610_005_0	9		1	07/08/2014	2015.02	07/08/2014 04:24:30 PM Central Daylight Time	08/01/2014 09:08:43 AM Central Daylight Time	08/01/2014 09:08:43 AM Central Daylight Time			08/01/2014 01:14:23 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	005	0	2015	St. Louis Metropolitan Area		2	42900	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2610	006	0	1	01	01	H2610_006_0	9		1	07/08/2014	2015.02	07/08/2014 04:02:31 PM Central Daylight Time	08/01/2014 09:08:44 AM Central Daylight Time	08/01/2014 09:08:44 AM Central Daylight Time			08/01/2014 01:14:23 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Plus (HMO)	01	01		1			H2610	006	0	2015	St. Louis Metropolitan Area		2	1955	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2610	011	0	1	01	01	H2610_011_0	11		1	07/08/2014	2015.02	07/08/2014 04:04:17 PM Central Daylight Time	08/01/2014 09:08:44 AM Central Daylight Time	08/01/2014 09:08:45 AM Central Daylight Time			08/01/2014 01:14:23 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage (HMO)	01	01		1			H2610	011	0	2015	Columbia Metropolitan Area		2	910	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2610	014	0	1	02	01	H2610_014_0	8		1	07/14/2014	2015.02	07/14/2014 12:49:22 PM Central Daylight Time	08/01/2014 09:08:45 AM Central Daylight Time	08/01/2014 09:08:46 AM Central Daylight Time			08/01/2014 01:14:23 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Platinum (HMO-POS)	01	02		1			H2610	014	0	2015	St. Louis County and City, St. Charles, Jefferson		2	417	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2610	015	0	1	01	01	H2610_015_0	9		1	07/08/2014	2015.02	07/08/2014 04:10:17 PM Central Daylight Time	08/01/2014 09:08:46 AM Central Daylight Time	08/01/2014 09:08:42 AM Central Daylight Time			08/01/2014 01:14:23 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	CoxHealth MedicarePlus (HMO)	01	01		1			H2610	015	0	2015	Southwest Missouri		2	1635	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2610	803	0	1	01	01	H2610_803_0	3		1	05/28/2014	2015.02	05/28/2014 11:18:53 AM Central Daylight Time	05/28/2014 02:26:04 PM Central Daylight Time				05/28/2014 04:26:33 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Employer Group Plan (HMO)	01	01		1			H2610	803	0	2015	MO and IL Service Area		1	50	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111110000100101111111011110000100	1	000001111011011111100000001	1					1
H2610	804	0	1	01	01	H2610_804_0	3		1	05/28/2014	2015.02	05/28/2014 11:19:02 AM Central Daylight Time	05/28/2014 02:27:52 PM Central Daylight Time				05/28/2014 04:26:33 PM Central Daylight Time	ESSENCE HEALTHCARE, INC.	Essence Healthcare	www.essencehealthcare.com	Essence Advantage Employer Group Plan non-calendar (HMO)	01	01		1			H2610	804	0	2015	MO and IL Service Area		1	50	2			2							www.essencehealthcare.com	www.essencehealthcare.com	www.essencehealthcare.com	(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(866)597-9560		(314)209-2700		(866)509-5399		(314)209-4800		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111110000100101111111011110000100	1	000001111011011111100000001	1					1
H2611	001	0	1	04	01	H2611_001_0	6		1	08/03/2014	2015.01	08/03/2014 01:35:03 PM Central Daylight Time	08/04/2014 04:11:38 PM Central Daylight Time	07/31/2014 04:25:01 PM Central Daylight Time			08/06/2014 02:30:27 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	Advantra (PPO)	01	04		1			H2611	001	0	2015	St. Louis Metro		2	1350	2			2							providerdirectory.coventry-medicare.com	http://coventry-medicare.coventryhealthcare.com/advantra-kansas/prescription-drug-benefits/formulary	http://providerdirectory.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(877)417-8652		(877)417-8652		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2611	008	0	1	04	01	H2611_008_0	3		1	08/04/2014	2015.01	08/04/2014 11:29:04 AM Central Daylight Time	08/04/2014 04:09:24 PM Central Daylight Time	08/01/2014 08:26:16 AM Central Daylight Time			08/06/2014 02:30:27 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Advantra Premier Plus (PPO)	01	04		1			H2611	008	0	2015	NW and Central Arkansas		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2611	018	0	1	04	01	H2611_018_0	3		1	08/04/2014	2015.01	08/04/2014 11:32:37 AM Central Daylight Time	08/04/2014 04:10:08 PM Central Daylight Time	08/01/2014 08:26:26 AM Central Daylight Time			08/06/2014 02:30:27 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Premier Plus (PPO)	01	04		1			H2611	018	0	2015	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2611	807	0	1	04	01	H2611_807_0	1		1	05/30/2014	2015.01	05/30/2014 11:07:15 AM Central Daylight Time	05/29/2014 11:10:48 PM Central Daylight Time				05/31/2014 01:34:10 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	Emp w Rx CY (PPO)	01	04		1			H2611	807	0	2015	Advantra for Empl (St. L Metro) Rx CY		1	12	2			2							providerdirectory.coventry-medicare.com	http://coventry-medicare.coventryhealthcare.com/advantra-kansas/prescription-drug-benefits/formulary	http://providerdirectory.coventry-medicare.com	(800)533-0367		(800)533-0367		(800)290-9738		(800)290-9738		(877)417-8652		(877)417-8652		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2611	809	0	1	04	01	H2611_809_0	2		1	04/25/2014	2015.01	05/09/2014 07:18:02 AM Central Daylight Time	07/17/2014 07:51:36 PM Central Daylight Time				07/24/2014 01:20:40 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://coventry-medicare.coventryhealthcare.com	Employer Group with RX CY (PPO)	01	04		1			H2611	809	0	2015	Southwest Missouri		1		2			2							http://providerdirectory.coventry-medicare.com	http://www.FHDFormulary.coventry-medicare.com	http://providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111001111000100	2		1					
H2611	824	0	1	04	01	H2611_824_0	1		1	05/30/2014	2015.01	05/30/2014 11:09:04 AM Central Daylight Time	05/29/2014 05:45:58 PM Central Daylight Time				05/31/2014 01:34:10 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.chcmissourimedicare.com	Employer Group Calendar Year no Rx (PPO)	01	04		1			H2611	824	0	2015	Advantra for Empl (St. L Metro) No Rx CY		1	12	2			2							providerdirectory.coventry-medicare.com	http://coventry-medicare.coventryhealthcare.com/advantra-kansas/prescription-drug-benefits/formulary	http://providerdirectory.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691										(711)-		(711)-		(711)-		(711)-										2					2					
H2649	004	0	1	01	01	H2649_004_0	3		1	08/02/2014	2015.01	08/02/2014 02:31:02 PM Eastern Daylight Time	08/04/2014 02:33:19 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-004 (HMO)	01	01		1			H2649	004	0	2015	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	012	0	1	01	01	H2649_012_0	2		1	07/11/2014	2015.01	07/11/2014 02:48:11 PM Eastern Daylight Time	07/11/2014 07:34:39 PM Eastern Daylight Time				07/14/2014 01:24:41 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-012 (HMO)	01	01		1			H2649	012	0	2015	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H2649	020	0	1	01	01	H2649_020_0	3		1	08/02/2014	2015.02	08/02/2014 02:18:48 PM Eastern Daylight Time	08/04/2014 02:39:11 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 09:09:34 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-020 (HMO)	01	01		1			H2649	020	0	2015	Southwest Missouri		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	021	0	1	01	01	H2649_021_0	4		1	08/02/2014	2015.01	08/02/2014 02:32:03 PM Eastern Daylight Time	08/04/2014 02:46:46 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-021 (HMO)	01	01		1			H2649	021	0	2015	Wichita area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	023	0	1	01	01	H2649_023_0	3		1	08/02/2014	2015.01	08/02/2014 02:32:35 PM Eastern Daylight Time	08/04/2014 02:43:42 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-023 (HMO)	01	01		1			H2649	023	0	2015	St. Louis Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	024	0	1	01	01	H2649_024_0	5		1	08/02/2014	2015.01	08/02/2014 02:33:46 PM Eastern Daylight Time	08/04/2014 02:45:18 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-024 (HMO)	01	01		1			H2649	024	0	2015	Kansas City Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	025	0	1	01	01	H2649_025_0	3		1	08/02/2014	2015.01	08/02/2014 02:34:38 PM Eastern Daylight Time	08/04/2014 02:47:39 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CHF/DM H2649-025 (HMO SNP)	01	01		1			H2649	025	0	2015	Southwest Missouri		2		2			1	4		1		00000000000000000100		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	028	0	1	01	01	H2649_028_0	4	2	1	08/02/2014	2015.01	08/02/2014 02:35:27 PM Eastern Daylight Time	08/04/2014 02:53:17 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H2649-028 (HMO SNP)	01	01		1			H2649	028	0	2015	Select counties in Missouri		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	029	0	1	01	01	H2649_029_0	3		1	08/02/2014	2015.02	08/02/2014 03:04:56 PM Eastern Daylight Time	08/04/2014 02:30:57 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-029 (HMO)	01	01		1			H2649	029	0	2015	Albuquerque Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	030	0	1	02	01	H2649_030_0	5		1	07/10/2014	2015.02	07/10/2014 12:32:53 PM Eastern Daylight Time	08/04/2014 05:07:07 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-030 (HMO-POS)	01	02		1			H2649	030	0	2015	Maricopa and Pinal (partial) counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	031	0	1	01	01	H2649_031_0	3		1	08/01/2014	2015.02	08/01/2014 07:39:33 PM Eastern Daylight Time	08/04/2014 05:00:25 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Community HMO (HMO)	01	01		1			H2649	031	0	2015	Pima and Pinal (partial) counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	032	0	1	01	01	H2649_032_0	4		1	08/01/2014	2015.02	08/01/2014 07:41:00 PM Eastern Daylight Time	08/04/2014 05:04:41 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-032 (HMO)	01	01		1			H2649	032	0	2015	Maricopa and Pinal (partial) counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	033	0	1	01	01	H2649_033_0	3		1	08/01/2014	2015.02	08/01/2014 07:42:25 PM Eastern Daylight Time	08/04/2014 05:09:05 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-033 (HMO)	01	01		1			H2649	033	0	2015	La Paz and Mohave counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	034	0	1	01	01	H2649_034_0	3		1	07/10/2014	2015.02	07/10/2014 12:50:26 PM Eastern Daylight Time	08/04/2014 05:08:23 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-034 (HMO)	01	01		1			H2649	034	0	2015	Yavapai County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	035	0	1	01	01	H2649_035_0	3		1	07/10/2014	2015.02	07/10/2014 12:53:35 PM Eastern Daylight Time	08/04/2014 05:10:48 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-035 (HMO)	01	01		1			H2649	035	0	2015	Yuma County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	036	0	1	01	01	H2649_036_0	3		1	08/01/2014	2015.02	08/01/2014 07:43:56 PM Eastern Daylight Time	08/04/2014 05:11:52 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H2649-036 (HMO SNP)	01	01		1			H2649	036	0	2015	Maricopa and Pinal (partial) counties		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	039	0	1	01	01	H2649_039_0	3		1	08/01/2014	2015.02	08/01/2014 07:46:21 PM Eastern Daylight Time	08/04/2014 05:12:20 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-039 (HMO)	01	01		1			H2649	039	0	2015	La Paz and Mohave counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	040	0	1	01	01	H2649_040_0	3		1	07/10/2014	2015.02	07/10/2014 12:59:18 PM Eastern Daylight Time	08/04/2014 05:13:11 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-040 (HMO)	01	01		1			H2649	040	0	2015	Yuma County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	041	0	1	01	01	H2649_041_0	3		1	07/10/2014	2015.02	07/10/2014 01:01:54 PM Eastern Daylight Time	08/04/2014 05:12:45 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-041 (HMO)	01	01		1			H2649	041	0	2015	Pima, Pinal (partial) and Santa Cruz counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	042	0	1	01	01	H2649_042_0	3		1	08/02/2014	2015.02	08/02/2014 03:32:23 PM Eastern Daylight Time	08/04/2014 02:32:07 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-042 (HMO)	01	01		1			H2649	042	0	2015	Colorado's I-25 Corridor Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	043	0	1	01	01	H2649_043_0	3		1	08/02/2014	2015.02	08/02/2014 03:06:54 PM Eastern Daylight Time	08/04/2014 02:40:41 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2649-043 (HMO)	01	01		1			H2649	043	0	2015	Colorado's I-25 Corridor Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2649	801	0	1	01	01	H2649_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:37:03 PM Eastern Daylight Time	07/14/2014 10:41:10 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	801	0	2015	Select counties in Kansas City Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2649	802	0	1	01	01	H2649_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:37:47 PM Eastern Daylight Time	07/14/2014 10:53:55 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	802	0	2015	Select counties in Kansas City Metro area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2649	807	0	1	01	01	H2649_807_0	2		1	05/23/2014	2015.02	05/23/2014 02:38:31 PM Eastern Daylight Time	07/14/2014 11:10:56 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	807	0	2015	Select Counties in AZ and NM		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2649	808	0	1	01	01	H2649_808_0	2		1	05/23/2014	2015.02	05/23/2014 02:39:15 PM Eastern Daylight Time	07/14/2014 11:11:43 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	808	0	2015	Select Counties in AZ and NM		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2649	814	0	1	01	01	H2649_814_0	2		1	05/23/2014	2015.02	05/23/2014 02:40:00 PM Eastern Daylight Time	07/14/2014 11:14:38 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	814	0	2015	Select Counties in Colorado		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2649	815	0	1	01	01	H2649_815_0	2		1	05/23/2014	2015.02	05/23/2014 02:40:47 PM Eastern Daylight Time	07/14/2014 11:15:21 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2649	815	0	2015	Select Counties in Colorado		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2654	010	0	1	01	01	H2654_010_0	2		1	05/29/2014	2015.02	05/29/2014 08:02:14 AM Central Daylight Time	08/04/2014 02:29:12 PM Central Daylight Time	07/31/2014 03:20:31 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2654	010	0	2015	Springfield, Missouri Area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2654	013	0	1	01	01	H2654_013_0	2		1	05/29/2014	2015.02	05/29/2014 08:38:36 AM Central Daylight Time	08/04/2014 02:30:28 PM Central Daylight Time	08/06/2014 10:43:50 AM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2654	013	0	2015	Select counties in Illinois and Missouri		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2654	033	0	1	01	01	H2654_033_0	2		1	05/23/2014	2015.02	05/23/2014 01:34:45 PM Central Daylight Time	08/04/2014 02:31:32 PM Central Daylight Time	07/31/2014 03:20:40 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H2654	033	0	2015	DuPage County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2654	801	0	1	01	01	H2654_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:07:22 AM Central Daylight Time	05/30/2014 05:04:13 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	801	0	2015	St Louis Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H2654	802	0	1	01	01	H2654_802_0	1		1	05/22/2014	2015.01	05/22/2014 09:07:30 AM Central Daylight Time	05/30/2014 05:04:37 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	802	0	2015	St Louis Area Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H2654	803	0	1	01	01	H2654_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:07:40 AM Central Daylight Time	05/30/2014 05:05:00 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	803	0	2015	Springfield Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H2654	804	0	1	01	01	H2654_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:07:52 AM Central Daylight Time	05/30/2014 05:05:23 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	804	0	2015	Springfield Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H2654	805	0	1	01	01	H2654_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:07:57 AM Central Daylight Time	05/30/2014 05:05:47 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	805	0	2015	St. Louis Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H2654	807	0	1	01	01	H2654_807_0	1		1	05/22/2014	2015.01	05/22/2014 09:08:13 AM Central Daylight Time	05/30/2014 05:06:10 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDWEST, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H2654	807	0	2015	Springfield Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H2663	002	0	1	01	01	H2663_002_0	6		1	08/05/2014	2015.01	08/05/2014 08:50:52 PM Central Daylight Time	08/04/2014 04:03:04 PM Central Daylight Time	08/01/2014 08:26:36 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Advantra Option 2 (HMO)	01	01		1			H2663	002	0	2015	St. Louis MO Metro Area		2	4527	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	005	0	1	01	01	H2663_005_0	6		1	08/05/2014	2015.01	08/05/2014 08:51:43 PM Central Daylight Time	08/05/2014 09:22:08 AM Central Daylight Time	08/01/2014 08:26:46 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Gold Advantage (HMO)	01	01		1			H2663	005	0	2015	St. Louis MO Metro Area		2	10821	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	006	0	1	02	01	H2663_006_0	5		1	08/03/2014	2015.01	08/03/2014 12:47:02 PM Central Daylight Time	08/04/2014 04:08:26 PM Central Daylight Time	08/01/2014 08:26:56 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Advantra Option 1 (HMO-POS)	01	02		1			H2663	006	0	2015	St. Louis MO Metro Area		2	4739	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	014	0	1	01	01	H2663_014_0	7	2	1	08/08/2014	2015.01	08/08/2014 10:59:10 AM Central Daylight Time	08/08/2014 09:43:28 AM Central Daylight Time	08/01/2014 08:27:07 AM Central Daylight Time			08/08/2014 03:10:54 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Advantra Dual Eligible SNP (HMO SNP)	01	01		1			H2663	014	0	2015	St. Louis MO Metro Area		2	8850	2			1	3		1	3		2	http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	015	0	1	02	01	H2663_015_0	4		1	08/03/2014	2015.01	08/03/2014 01:00:47 PM Central Daylight Time	08/04/2014 04:10:20 PM Central Daylight Time	08/01/2014 08:27:16 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Coventry Total Care (HMO-POS)	01	02		1			H2663	015	0	2015	St. Louis MO Metro Area		2	4739	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	016	0	1	01	01	H2663_016_0	4		1	08/03/2014	2015.01	08/03/2014 01:08:08 PM Central Daylight Time	08/05/2014 10:48:06 AM Central Daylight Time	08/01/2014 08:27:26 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Coventry Total Care (HMO)	01	01		1			H2663	016	0	2015	Boone, Winnebago Illinois		2	1348	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	017	0	1	01	01	H2663_017_0	4		1	08/03/2014	2015.01	08/03/2014 01:11:28 PM Central Daylight Time	08/05/2014 10:49:14 AM Central Daylight Time	08/01/2014 08:27:37 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Coventry Total Care (HMO)	01	01		1			H2663	017	0	2015	Peoria, Tazewell Illinois		2	1348	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	018	0	1	01	01	H2663_018_0	4		1	08/03/2014	2015.01	08/03/2014 01:14:16 PM Central Daylight Time	08/05/2014 10:50:38 AM Central Daylight Time	08/01/2014 08:27:47 AM Central Daylight Time			08/06/2014 03:18:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Advantra (HMO)	01	01		1			H2663	018	0	2015	Peoria, Tazewell Illinois		2	1000	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	802	0	1	01	01	H2663_802_0	3		1	06/06/2014	2015.01	06/06/2014 08:43:36 AM Central Daylight Time	06/20/2014 05:18:34 PM Central Daylight Time				07/21/2014 08:34:22 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Employer Group Calendar Rx (HMO)	01	01		1			H2663	802	0	2015	St. Louis MO Metro Area - Employer Group		1	12	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	804	0	1	01	01	H2663_804_0	2		1	07/21/2014	2015.01	07/21/2014 08:32:43 AM Central Daylight Time	06/21/2014 09:47:35 AM Central Daylight Time				07/21/2014 08:34:22 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Employer Group Non Calendar Rx (HMO)	01	01		1			H2663	804	0	2015	St. Louis MO Metro Area - Employer Group		1	12	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2663	805	0	1	01	01	H2663_805_0	4		1	06/20/2014	2015.01	06/20/2014 10:44:58 AM Central Daylight Time	07/17/2014 08:24:22 PM Central Daylight Time				07/24/2014 01:13:56 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Employer Group Calendar No Rx (HMO)	01	01		1			H2663	805	0	2015	St. Louis MO Metro Area - Employer Group		1	12	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691										(711)-		(711)-		(711)-		(711)-										2					2					1
H2663	810	0	1	01	01	H2663_810_0	3		1	05/29/2014	2015.01	05/29/2014 01:45:00 PM Central Daylight Time	06/21/2014 10:29:59 AM Central Daylight Time				07/21/2014 08:34:22 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care of Missouri, Inc.	www.chcmissourimedicare.com	Employer Group SOI w/Rx (HMO)	01	01		1			H2663	810	0	2015	Illinois		1	5000	2			2							http://providerdirectory.coventry-medicare.com	www.MOFormulary.coventry-medicare.com	http:pharmacylocator.coventry-medicare.com	(800)533-0367		(800)533-0367		(855)893-4691		(855)893-4691		(866)291-8628		(866)291-8628		(855)893-4691		(855)893-4691		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100010001100111111111011110000110	1	000000001010100000000000000	1					1
H2667	001	0	1	01	01	H2667_001_0	5		1	08/04/2014	2015.01	08/04/2014 11:36:12 AM Central Daylight Time	08/08/2014 09:29:00 AM Central Daylight Time	08/01/2014 08:27:57 AM Central Daylight Time			08/08/2014 01:28:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Advantage (HMO)	01	01		1			H2667	001	0	2015	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2667	012	0	1	01	01	H2667_012_0	2		1	07/10/2014	2015.01	07/10/2014 11:21:43 AM Central Daylight Time	05/28/2014 05:44:12 PM Central Daylight Time				07/10/2014 03:04:25 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Advantage (no drug) (HMO)	01	01		1			H2667	012	0	2015	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447										(711)-		(711)-		(711)-		(711)-										2					2					2
H2667	017	0	1	02	01	H2667_017_0	7		1	08/04/2014	2015.01	08/04/2014 11:40:08 AM Central Daylight Time	08/08/2014 09:30:00 AM Central Daylight Time	08/01/2014 08:28:07 AM Central Daylight Time			08/08/2014 01:28:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	coventry-medicare.coventryhealthcare.com	Coventry Advantage Plus (HMO-POS)	01	02		1			H2667	017	0	2015	Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2667	807	0	1	01	01	H2667_807_0	3		1	06/20/2014	2015.01	06/20/2014 10:45:33 AM Central Daylight Time	06/25/2014 09:18:46 AM Central Daylight Time				07/21/2014 08:19:50 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	http://coventry-medicare.coventryhealthcare.com	Employer Group With  RX CY (HMO)	01	01		1			H2667	807	0	2015	Southwest Missouri		1		2			2							http://providerdirectory.coventry-medicare.com	http://www.FHDFormulary.coventry-medicare.com	http://providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111001111000100	2		1					1
H2667	808	0	1	01	01	H2667_808_0	2		1	05/08/2014	2015.01	05/08/2014 09:04:05 AM Central Daylight Time	06/25/2014 09:22:27 AM Central Daylight Time				07/21/2014 08:19:50 AM Central Daylight Time	COVENTRY HEALTH CARE OF MISSOURI, INC	Coventry Health Care	http://coventry-medicare.coventryhealthcare.com	Employer Group  no RX CY (HMO)	01	01		1			H2667	808	0	2015	Southwest Missouri		1		2			2							http://providerdirectory.coventry-medicare.com	http://www.FHDFormulary.coventry-medicare.com	http://providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100101110111001111000100	2		1					1
H2672	001	0	1	01	01	H2672_001_0	5		1	08/05/2014	2015.01	08/05/2014 05:37:24 PM Central Daylight Time	08/06/2014 06:30:59 AM Central Daylight Time	08/01/2014 08:28:18 AM Central Daylight Time			08/06/2014 07:05:29 AM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Advantage (HMO)	01	01		1			H2672	001	0	2015	Kansas City Metro Area		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2672	008	0	1	01	01	H2672_008_0	4		1	08/04/2014	2015.01	08/04/2014 09:29:23 AM Central Daylight Time	08/06/2014 06:31:56 AM Central Daylight Time	08/01/2014 08:28:28 AM Central Daylight Time			08/06/2014 07:05:29 AM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Advantage (HMO)	01	01		1			H2672	008	0	2015	Wyandotte County		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2672	009	0	1	01	01	H2672_009_0	5		1	08/04/2014	2015.01	08/04/2014 10:43:21 AM Central Daylight Time	08/04/2014 04:13:32 PM Central Daylight Time	08/01/2014 08:28:38 AM Central Daylight Time			08/06/2014 02:53:32 AM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Coventry Medicare Advantage Total Care (HMO)	01	01		1			H2672	009	0	2015	Wichita Kansas Area		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2672	010	0	1	01	01	H2672_010_0	4		1	08/04/2014	2015.01	08/04/2014 10:46:29 AM Central Daylight Time	08/04/2014 04:14:12 PM Central Daylight Time	08/01/2014 08:28:49 AM Central Daylight Time			08/06/2014 02:53:32 AM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Total Care (HMO)	01	01		1			H2672	010	0	2015	NW Arkansas		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2672	012	0	1	01	01	H2672_012_0	4		1	08/04/2014	2015.01	08/04/2014 10:49:13 AM Central Daylight Time	08/08/2014 09:30:46 AM Central Daylight Time	08/01/2014 08:28:59 AM Central Daylight Time			08/08/2014 02:21:17 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Coventry Advantage (HMO)	01	01		1			H2672	012	0	2015	Oklahoma and Canadian County		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2672	017	0	1	01	01	H2672_017_0	3		1	07/10/2014	2015.01	07/10/2014 10:36:58 AM Central Daylight Time	05/28/2014 05:53:44 PM Central Daylight Time				07/10/2014 03:22:48 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Coventry Select (no drug) (HMO)	01	01		1			H2672	017	0	2015	Limited counties Missouri and Kansas		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446										(711)-		(711)-		(711)-		(711)-										2					2					2
H2672	018	0	1	01	01	H2672_018_0	5		1	07/10/2014	2015.01	07/10/2014 02:15:09 PM Central Daylight Time	08/11/2014 01:43:52 PM Central Daylight Time	08/01/2014 08:29:09 AM Central Daylight Time			08/11/2014 02:06:53 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Select Plus (HMO)	01	01		1			H2672	018	0	2015	Partial State AR, KS, MO, OK		2	500	2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(866)294-9803		(866)294-9803		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2672	801	0	1	01	01	H2672_801_0	1		1	05/09/2014	2015.01	05/09/2014 08:22:13 AM Central Daylight Time	05/29/2014 10:33:42 PM Central Daylight Time				05/31/2014 01:24:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Employer Group (HMO)	01	01		1			H2672	801	0	2015	Arkansas, Kansas, Missouri		1		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111001111000100	2		1					1
H2672	802	0	1	01	01	H2672_802_0	2		1	05/09/2014	2015.01	05/09/2014 08:39:06 AM Central Daylight Time	05/31/2014 10:38:06 AM Central Daylight Time				05/31/2014 04:02:03 PM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Employer Group (HMO)	01	01		1			H2672	802	0	2015	Arkansas, Kansas, Missouri		1		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111001111000100	2		1					1
H2672	803	0	1	01	01	H2672_803_0	1		1	05/09/2014	2015.01	05/09/2014 08:53:59 AM Central Daylight Time	05/29/2014 10:20:50 PM Central Daylight Time				05/31/2014 01:24:05 AM Central Daylight Time	COVENTRY HEALTH CARE OF KANSAS, INC.	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Employer Group (HMO)	01	01		1			H2672	803	0	2015	Arkansas, Kansas, Missouri		1		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100101110111001111000100	2		1					1
H2676	001	0	1	04	01	H2676_001_0	5		1	05/22/2014	2015.02	05/22/2014 02:31:12 PM Central Daylight Time	08/04/2014 08:13:24 AM Central Daylight Time	07/31/2014 03:58:55 PM Central Daylight Time			08/05/2014 10:38:40 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (PPO)	01	04		1			H2676	001	0	2015	Select Counties of Texas and Arkansas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2701	003	0	1	04	01	H2701_003_0	6		1	07/18/2014	2015.01	07/18/2014 10:32:36 AM Mountain Daylight Time	08/01/2014 03:03:52 PM Mountain Daylight Time	05/30/2014 01:45:32 PM Mountain Daylight Time			08/01/2014 03:07:00 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Value (PPO)	01	04		1			H2701	003	0	2015	Selected Counties in Montana		2	13100	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2701	006	0	1	04	01	H2701_006_0	5		1	07/11/2014	2015.01	07/11/2014 03:08:36 PM Mountain Daylight Time	05/30/2014 04:23:00 PM Mountain Daylight Time	05/30/2014 01:46:02 PM Mountain Daylight Time			08/01/2014 03:09:15 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Basic (PPO)	01	04		1			H2701	006	0	2015	Selected Counties in Montana		2	4109	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2701	806	0	1	04	01	H2701_806_0	6		1	05/21/2014	2015.01	05/21/2014 09:09:39 AM Mountain Daylight Time	05/30/2014 05:03:00 PM Mountain Daylight Time				06/10/2014 09:07:24 AM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Group Plus (PPO)	01	04		1			H2701	806	0	2015	National		1	204	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100001000000000000000011100000100	2		1					
H2701	807	0	1	04	01	H2701_807_0	5		1	05/21/2014	2015.01	05/21/2014 09:09:59 AM Mountain Daylight Time	05/30/2014 05:04:58 PM Mountain Daylight Time				05/31/2014 08:07:14 PM Mountain Daylight Time	NEW WEST HEALTH SERVICES	New West Health Services	www.newwestmedicare.com	New West Medicare Group Plus (PPO)	01	04		1			H2701	807	0	2015	National		1	850	2			2							www.newwestmedicare.com	www.newwestmedicare.com	www.newwestmedicare.com	(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(888)873-8049		(406)457-2200		(888)873-8044		(406)457-2200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100001000000000000000011100000100	2		1					
H2751	002	0	1	48	05	H2751_002_0	6		1	08/01/2014	2015.02	08/01/2014 10:42:05 AM Eastern Daylight Time					08/01/2014 10:58:45 AM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.fida.wellcareny.com	WellCare Advocate Complete FIDA (Medicare-Medicaid Plan)	05	48		1			H2751	002	0	2015	Brnx-Kngs-Nsau-NewYork-Queens-Rchmnd-Sflk-Wstchstr		2	100	2			2							www.fida.wellcareny.com	www.fida.wellcareny.com	www.fida.wellcareny.com	(855)595-2063		(855)595-2063		(877)817-5794		(877)817-5794		(855)595-2063		(855)595-2063		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H2758	002	0	1	01	01	H2758_002_0	7		1	08/05/2014	2015.01	08/05/2014 11:56:26 AM Eastern Daylight Time	08/06/2014 10:11:37 AM Eastern Daylight Time	08/06/2014 10:11:39 AM Eastern Daylight Time			08/06/2014 10:16:52 AM Eastern Daylight Time	BEHEALTHY AMERICA, INC.	BeHealthy America, Inc.	www.behealthyus.com	BeHealthy America (HMO)	01	01		1			H2758	002	0	2015	Manate and Sarasota counties		2	24000	2			2							www.behealthyus.com	www.behealthyus.com	www.behealthyus.com	(855)522-2870		(941)556-0770		(855)522-2870		(941)556-0770		(855)522-2870		(941)556-0770		(855)522-2870		(941)556-0770		(855)522-2973		(941)556-0587		(855)522-2973		(941)556-0587		(855)522-2973		(941)556-0587		(855)522-2973		(941)556-0587		2					2					2
H2773	003	0	1	01	01	H2773_003_0	8		1	08/06/2014	2015.01	08/06/2014 03:39:55 PM Eastern Daylight Time	08/10/2014 04:33:51 PM Eastern Daylight Time	08/06/2014 04:38:01 PM Eastern Daylight Time			08/10/2014 04:41:53 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Health NY - SNP (HMO SNP)	01	01		1			H2773	003	0	2015	Nassau, and Suffolk Counties		2	600	2			1	4		1		00000000000000000010		www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2773	013	0	1	01	01	H2773_013_0	7		1	08/06/2014	2015.01	08/06/2014 03:20:53 PM Eastern Daylight Time	08/10/2014 04:34:20 PM Eastern Daylight Time	08/06/2014 04:38:19 PM Eastern Daylight Time			08/10/2014 04:41:53 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Silver - Queens (HMO)	01	01		1			H2773	013	0	2015	Queens County		2	450	2			2							www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2773	015	0	1	01	01	H2773_015_0	9		1	08/06/2014	2015.01	08/06/2014 03:21:09 PM Eastern Daylight Time	08/10/2014 04:34:54 PM Eastern Daylight Time	08/06/2014 04:38:39 PM Eastern Daylight Time			08/10/2014 04:41:53 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Platinum Plus NY (HMO)	01	01		1			H2773	015	0	2015	Nassau, Queens, Staten Island and Suffolk Counties		2	140	2			2							www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2773	017	0	1	01	01	H2773_017_0	8		1	08/06/2014	2015.01	08/06/2014 03:21:23 PM Eastern Daylight Time	08/10/2014 04:37:42 PM Eastern Daylight Time	08/10/2014 04:39:42 PM Eastern Daylight Time			08/10/2014 04:41:53 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Health NYC - SNP (HMO SNP)	01	01		1			H2773	017	0	2015	Queens County and Staten Island		2	1000	2			1	4		1		00000000000000000010		www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2773	018	0	1	01	01	H2773_018_0	7	2	1	08/06/2014	2015.01	08/06/2014 03:21:43 PM Eastern Daylight Time	08/10/2014 04:38:32 PM Eastern Daylight Time	08/06/2014 04:39:16 PM Eastern Daylight Time			08/10/2014 04:41:53 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Value One NY - Dual (HMO SNP)	01	01		1			H2773	018	0	2015	Nassau, Queens, Staten Island and Suffolk Counties		2	700	2			1	3		1	2			www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2773	019	0	1	01	01	H2773_019_0	8		1	08/06/2014	2015.01	08/06/2014 03:21:58 PM Eastern Daylight Time	08/10/2014 04:39:03 PM Eastern Daylight Time	08/06/2014 04:39:37 PM Eastern Daylight Time			08/10/2014 04:41:53 PM Eastern Daylight Time	QUALITY HEALTH PLANS OF NEW YORK, INC.	QUALITY HEALTH PLANS	www.qualityhealthplansny.com	Advantage Silver - NY (HMO)	01	01		1			H2773	019	0	2015	Nassau, Staten Island and Suffolk Counties		2	680	2			2							www.qualityhealthplansny.com	www.qualityhealthplansny.com	www.qualityhealthplansny.com	(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(877)233-7058		(631)403-4265		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2775	082	0	1	04	01	H2775_082_0	8		1	07/29/2014	2015.01	07/29/2014 10:29:52 AM Central Daylight Time	08/04/2014 02:30:58 PM Central Daylight Time	07/31/2014 04:26:25 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	082	0	2015	Select Counties in NY, ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2775	083	0	1	04	01	H2775_083_0	8		1	07/21/2014	2015.01	07/21/2014 04:53:54 PM Central Daylight Time	08/04/2014 02:31:14 PM Central Daylight Time	07/31/2014 04:26:31 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 150A (PPO)	01	04		1			H2775	083	0	2015	Select Counties in NY, ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2775	088	0	1	04	01	H2775_088_0	8		1	07/21/2014	2015.01	07/21/2014 04:53:59 PM Central Daylight Time	08/04/2014 02:31:29 PM Central Daylight Time	07/31/2014 04:26:37 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 350B (PPO)	01	04		1			H2775	088	0	2015	Select Counties in NY, ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2775	089	0	1	04	01	H2775_089_0	7		1	07/21/2014	2015.01	07/21/2014 04:54:04 PM Central Daylight Time	08/04/2014 02:31:46 PM Central Daylight Time	07/31/2014 04:26:44 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage Plus 350B (PPO)	01	04		1			H2775	089	0	2015	Select Counties in NY,ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2775	095	0	1	04	01	H2775_095_0	5		1	07/21/2014	2015.01	07/21/2014 04:54:10 PM Central Daylight Time	07/18/2014 03:43:04 PM Central Daylight Time				07/21/2014 05:27:52 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options Advantage 200 (PPO)	01	04		1			H2775	095	0	2015	Select Counties in NY,ME		2		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967										(711)-		(711)-		(711)-		(711)-										2					2					2
H2775	801	0	1	04	01	H2775_801_0	3		1	05/29/2014	2015.01	05/29/2014 11:52:01 AM Central Daylight Time	06/09/2014 10:06:04 AM Central Daylight Time				06/09/2014 10:06:35 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options PPO - MA Group Plan (PPO)	01	04		1			H2775	801	0	2015	National		1		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2775	802	0	1	04	01	H2775_802_0	3		1	05/29/2014	2015.01	05/29/2014 11:53:29 AM Central Daylight Time	06/09/2014 10:06:06 AM Central Daylight Time				06/09/2014 10:06:35 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options PPO - MAPD Group Plan (PPO)	01	04		1			H2775	802	0	2015	National		1		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2775	803	0	1	04	01	H2775_803_0	3		1	05/29/2014	2015.01	05/29/2014 11:55:34 AM Central Daylight Time	06/09/2014 10:06:07 AM Central Daylight Time				06/09/2014 10:06:35 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptionsPPO.com	Today's Options PPO - MAPD Group Plan - NCY (PPO)	01	04		1			H2775	803	0	2015	National		1		2			2							www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	http://www.TodaysOptionsPPO.com	(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(866)422-5009		(866)422-5009		(866)422-1967		(866)422-1967		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H2792	001	0	1	07	02	H2792_001_0	2		2	06/02/2014	2015.02	06/02/2014 03:42:12 PM Eastern Daylight Time			06/02/2014 10:40:52 AM Eastern Daylight Time		06/02/2014 03:56:39 PM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Reserve 100 (MSA)	02	07	2	1			H2792	001	0	2015	New Jersey Monmouth and Ocean Counties		2		2			2							www.MeridianGeisingerGold.com			(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376										(711)-		(711)-		(711)-		(711)-																				
H2792	801	0	1	07	02	H2792_801_0	4		2	06/03/2014	2015.02	06/03/2014 11:29:00 AM Eastern Daylight Time			06/02/2014 10:42:26 AM Eastern Daylight Time		06/04/2014 11:26:58 AM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Reserve 100 (Employer Group) (MSA)	02	07	2	1			H2792	801	0	2015	New Jersey		1		2			2							www.MeridianGeisingerGold.com			(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376										(711)-		(711)-		(711)-		(711)-																				
H2802	001	0	1	01	01	H2802_001_0	2		1	05/29/2014	2015.02	05/29/2014 08:01:09 AM Central Daylight Time	08/04/2014 02:32:51 PM Central Daylight Time	07/31/2014 03:20:44 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H2802	001	0	2015	Douglas and Pottawattamie counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2810	001	0	1	04	01	H2810_001_0	6		1	08/08/2014	2015.01	08/08/2014 12:27:42 PM Pacific Daylight Time	08/05/2014 09:03:02 AM Pacific Daylight Time	08/05/2014 09:03:42 AM Pacific Daylight Time			08/08/2014 01:46:51 PM Pacific Daylight Time	GROUP HEALTH OPTIONS	Group Health Options, Inc.	www.ghc.org/medicare	Group Health Options Inc. Prestige (PPO)	01	04		1			H2810	001	0	2015	Jefferson and Clallam Counties		2		2			2							http://www.ghc.org/provider/index.jhtml	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					
H2815	001	0	1	20	08	H2815_001_0	1		1	05/19/2014	2015.01	05/19/2014 09:19:06 AM Mountain Daylight Time		05/19/2014 08:54:50 AM Mountain Daylight Time			05/19/2014 10:46:13 AM Mountain Daylight Time	VOLUNTEERS OF AMERICA NATIONAL SERVICES	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	001	0	2015	Senior CommUnity Care of Colorado		2		2			2								www.voa.org	www.voa.org									(888)476-8120		(970)252-0522		(888)476-8120		(970)252-0522										(970)835-4072		(970)252-0522		(970)835-4072		(970)252-0522												
H2815	002	0	1	20	08	H2815_002_0	1		1	05/19/2014	2015.01	05/19/2014 10:44:10 AM Mountain Daylight Time		05/19/2014 08:55:25 AM Mountain Daylight Time			05/19/2014 10:46:13 AM Mountain Daylight Time	VOLUNTEERS OF AMERICA NATIONAL SERVICES	Senior CommUnity Care of Colorado	www.seniorcommunitycare.org	Senior CommUnity Care of Colorado (PACE)	08	20		1			H2815	002	0	2015	Senior CommUnity Care of Colorado		2		2			2								www.voa.org	www.voa.org									(888)476-8120		(970)252-0522		(888)476-8120		(970)252-0522										(970)835-4072		(970)252-0522		(970)835-4072		(970)252-0522												
H2816	001	0	1	09	04	H2816_001_0	5		1	07/21/2014	2015.01	07/21/2014 05:13:55 PM Central Daylight Time	07/18/2014 03:37:45 PM Central Daylight Time				07/21/2014 05:27:52 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 100 (PFFS)	04	09	1	1			H2816	001	0	2015	Select counties in NY,ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2
H2816	002	0	1	09	04	H2816_002_0	5		1	07/21/2014	2015.01	07/21/2014 04:58:52 PM Central Daylight Time	07/18/2014 03:39:33 PM Central Daylight Time				07/21/2014 05:27:52 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 100 (PFFS)	04	09	1	1			H2816	002	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2
H2816	007	0	1	09	04	H2816_007_0	6		1	07/21/2014	2015.01	07/21/2014 04:59:41 PM Central Daylight Time	07/18/2014 03:42:15 PM Central Daylight Time				07/21/2014 05:27:52 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	007	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2
H2816	008	0	1	09	04	H2816_008_0	5		1	07/21/2014	2015.01	07/21/2014 04:59:51 PM Central Daylight Time	07/18/2014 03:38:21 PM Central Daylight Time				07/21/2014 05:27:52 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier 200 (PFFS)	04	09	1	1			H2816	008	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										2					2					2
H2816	013	0	1	09	04	H2816_013_0	8		1	07/21/2014	2015.01	07/21/2014 05:00:02 PM Central Daylight Time	08/04/2014 02:33:23 PM Central Daylight Time	07/31/2014 04:26:50 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 150A (PFFS)	04	09	1	1			H2816	013	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2816	019	0	1	09	04	H2816_019_0	8		1	07/21/2014	2015.01	07/21/2014 05:00:16 PM Central Daylight Time	08/04/2014 02:33:38 PM Central Daylight Time	07/31/2014 04:26:56 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 350B (PFFS)	04	09	1	1			H2816	019	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2816	021	0	1	09	04	H2816_021_0	8		1	07/21/2014	2015.01	07/21/2014 05:01:01 PM Central Daylight Time	08/04/2014 02:33:54 PM Central Daylight Time	07/31/2014 04:27:03 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 350B (PFFS)	04	09	1	1			H2816	021	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2816	027	0	1	09	04	H2816_027_0	8		1	07/21/2014	2015.01	07/21/2014 05:00:45 PM Central Daylight Time	08/04/2014 02:34:14 PM Central Daylight Time	07/31/2014 04:27:09 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options Premier Plus 150A (PFFS)	04	09	1	1			H2816	027	0	2015	Select counties in NY and ME		2		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2816	801	0	1	09	04	H2816_801_0	2		1	05/29/2014	2015.01	05/29/2014 11:56:00 AM Central Daylight Time	05/31/2014 07:38:47 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options PFFS - MA Group Plan (PFFS)	04	09	1	1			H2816	801	0	2015	National		1		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923										(711)-		(711)-		(711)-		(711)-										1					1					1
H2816	802	0	1	09	04	H2816_802_0	2		1	05/29/2014	2015.01	05/29/2014 11:56:21 AM Central Daylight Time	05/31/2014 07:39:19 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options PFFS - MAPD Group Plan (PFFS)	04	09	1	1			H2816	802	0	2015	National		1		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1
H2816	803	0	1	09	04	H2816_803_0	2		1	05/29/2014	2015.01	05/29/2014 11:56:49 AM Central Daylight Time	05/31/2014 07:39:51 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Universal American Corp.	www.TodaysOptions.com	Today's Options PFFS - MAPD Group Plan - NCY (PFFS)	04	09	1	1			H2816	803	0	2015	National		1		2			2								www.TodaysOptions.com	www.TodaysOptions.com	(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(866)568-8921		(866)568-8921		(866)418-1923		(866)418-1923		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1					1					1
H2836	004	0	1	04	01	H2836_004_0	14		1	07/23/2014	2015.01	07/23/2014 09:39:32 AM Pacific Daylight Time	08/05/2014 11:51:27 PM Pacific Daylight Time	08/01/2014 02:30:53 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Preferred Standard (PPO)	01	04		1			H2836	004	0	2015	Hartford County		2	1595	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2836	801	0	1	04	01	H2836_801_0	7		1	05/30/2014	2015.01	05/30/2014 03:09:13 PM Pacific Daylight Time	07/15/2014 03:50:31 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Preferred (PPO)	01	04		1			H2836	801	0	2015	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H2836	802	0	1	04	01	H2836_802_0	7		1	05/30/2014	2015.01	05/30/2014 03:09:18 PM Pacific Daylight Time	07/15/2014 03:50:43 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Preferred (PPO)	01	04		1			H2836	802	0	2015	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H2836	803	0	1	04	01	H2836_803_0	7		1	05/30/2014	2015.01	05/30/2014 03:09:24 PM Pacific Daylight Time	07/15/2014 03:50:57 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Preferred (PPO)	01	04		1			H2836	803	0	2015	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(855)397-9261		(855)397-9261		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H2879	001	0	1	01	01	H2879_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 08:50:57 AM Pacific Daylight Time	08/05/2014 11:09:00 AM Pacific Daylight Time	08/05/2014 09:36:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF WISCONSIN	Molina Healthcare of Wisconsin	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H2879	001	0	2015	Wisconsin		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(855)315-5663		(855)315-5663		(866)403-8293		(866)403-8293		(855)315-5663		(855)315-5663		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2905	001	0	1	04	01	H2905_001_0	4		1	05/30/2014	2015.02	05/30/2014 04:28:58 PM Central Daylight Time	08/04/2014 02:35:24 PM Central Daylight Time	07/31/2014 03:21:27 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Sierra Health and Life Insurance Company, Inc.	www.sierraspectrumppo.com	Sierra Spectrum (PPO)	01	04		1			H2905	001	0	2015	Washington county		2		2			2							www.sierraspectrumppo.com	www.sierraspectrumppo.com	www.sierraspectrumppo.com	(877)559-4512		(877)559-4512		(877)271-8591		(877)271-8591		(877)559-4512		(877)559-4512		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2906	003	0	1	04	01	H2906_003_0	6		1	08/05/2014	2015.01	08/05/2014 01:02:36 PM Pacific Daylight Time	08/07/2014 09:38:56 AM Pacific Daylight Time	08/07/2014 09:38:57 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Premier Plan (PPO)	01	04		1			H2906	003	0	2015	Washoe County, NV		2	327	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2906	005	0	1	04	01	H2906_005_0	6		1	08/06/2014	2015.01	08/06/2014 06:41:33 PM Pacific Daylight Time	08/07/2014 09:38:58 AM Pacific Daylight Time	08/07/2014 09:38:58 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Select Plan (PPO)	01	04		1			H2906	005	0	2015	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	392	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2906	006	0	1	04	01	H2906_006_0	6		1	08/06/2014	2015.01	08/06/2014 06:42:05 PM Pacific Daylight Time	08/07/2014 09:38:59 AM Pacific Daylight Time	08/07/2014 09:39:00 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Enhanced Plan (PPO)	01	04		1			H2906	006	0	2015	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	1786	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2906	007	0	1	04	01	H2906_007_0	6		1	07/23/2014	2015.01	07/23/2014 09:49:11 PM Pacific Daylight Time	08/07/2014 09:39:01 AM Pacific Daylight Time	08/07/2014 09:39:01 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Rx Plan (PPO)	01	04		1			H2906	007	0	2015	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	1333	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2906	008	0	1	04	01	H2906_008_0	4		1	07/23/2014	2015.01	07/23/2014 09:51:12 PM Pacific Daylight Time	07/23/2014 01:23:19 PM Pacific Daylight Time				07/24/2014 07:25:58 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Basic Plan (PPO)	01	04		1			H2906	008	0	2015	Carson City, Churchill, Douglas, Lyon, Storey - NV		2	200	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-										2					2					
H2906	801	0	1	04	01	H2906_801_0	2		1	07/24/2014	2015.01	07/24/2014 07:23:33 PM Pacific Daylight Time	07/23/2014 01:23:31 PM Pacific Daylight Time				07/24/2014 07:25:58 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Freedom Group (PPO)	01	04		1			H2906	801	0	2015	State of Nevada		1	38	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100100110110001111000100	1	011111000100100110110010000	1					
H2926	001	0	1	01	01	H2926_001_0	3	2	1	06/02/2014	2015.01	06/02/2014 09:05:37 AM Central Daylight Time	08/05/2014 09:29:50 AM Central Daylight Time	08/05/2014 09:30:52 AM Central Daylight Time			08/06/2014 10:46:12 AM Central Daylight Time	PRIMEWEST CTRL COUNTY-BASED PURCHASING INTIATIVE	PrimeWest Health	www.primewest.org/Members/PHC_HMO.aspx	Prime Health Complete (HMO SNP)	01	01		1			H2926	001	0	2015	Northern, west central, and southwestern Minnesota		2	221	2			1	3		1	5			www.primewest.org/FindA/Default.aspx	http://www.primewest.org/FindA/Drug.aspx	http://www.primewest.org/FindA/Pharmacy.aspx	(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(877)600-4913		(320)335-5243		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		(800)627-3529		1	1	011100010100000001111111011100000000	2		1					1
H2931	002	0	1	01	01	H2931_002_0	4		1	05/30/2014	2015.02	05/30/2014 04:29:11 PM Central Daylight Time	08/04/2014 02:36:45 PM Central Daylight Time	07/31/2014 03:21:31 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Senior Dimensions Southern Nevada (HMO)	01	01		1			H2931	002	0	2015	Clark and Nye counties		2		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2931	004	0	1	01	01	H2931_004_0	4		1	05/30/2014	2015.02	05/30/2014 04:29:21 PM Central Daylight Time	08/04/2014 02:37:47 PM Central Daylight Time	07/31/2014 03:21:36 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Senior Dimensions Greater Nevada (HMO)	01	01		1			H2931	004	0	2015	Lyon, Mineral, Esmeralda, and portions of Washoe		2		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2931	801	0	1	01	01	H2931_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:09:07 AM Central Daylight Time	05/30/2014 06:40:14 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Basic Group (with Drug) Coverage (HMO)	01	01		1			H2931	801	0	2015	Counties: Clk, Esmrld, Ny, Lyn, Mnrl, parts of Wsh		1		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H2931	803	0	1	01	01	H2931_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:09:25 AM Central Daylight Time	05/30/2014 06:40:50 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	Basic Group MA Only Coverage (HMO)	01	01		1			H2931	803	0	2015	Counties: Clk, Esmrld, Ny, Lyn, Mnrl, parts of Wsh		1		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H2931	804	0	1	01	01	H2931_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:09:31 AM Central Daylight Time	05/30/2014 06:41:22 PM Central Daylight Time				05/31/2014 11:56:27 AM Central Daylight Time	HEALTH PLAN OF NEVADA, INC.	Health Plan of Nevada, Inc.	www.SeniorDimensions.com	(NCY) Basic Group (With Drug) Coverage (HMO)	01	01		1			H2931	804	0	2015	Counties: Clk, Esmrld, Ny, Lyn, Mnrl, parts of Wsh		1		2			2							www.SeniorDimensions.com	www.SeniorDimensions.com	www.SeniorDimensions.com	(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(800)650-6232		(800)650-6232		(877)271-8591		(877)271-8591		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H2936	001	0	1	20	08	H2936_001_0	1		1	05/20/2014	2015.01	05/20/2014 09:14:56 AM Eastern Daylight Time		05/16/2014 04:22:44 PM Eastern Daylight Time			05/20/2014 09:17:01 AM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	LifeCircles (PACE)	08	20		1			H2936	001	0	2015	Muskegon, Ottawa		2		2			2								www.lifecircles-pace.org	www.lifecircles-pace.org									(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686												
H2936	002	0	1	20	08	H2936_002_0	1		1	05/20/2014	2015.01	05/20/2014 09:15:15 AM Eastern Daylight Time		05/16/2014 04:32:17 PM Eastern Daylight Time			05/20/2014 09:17:01 AM Eastern Daylight Time	LIFECIRCLES	LIFECIRCLES	http:www.lifecircles-pace.org	002 - Medicare Only (PACE)	08	20		1			H2936	002	0	2015	002 - Medicare Only		2		2			2								www.lifecircles-pace.org	www.lifecircles-pace.org									(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686										(888)204-8626		(231)733-8686		(888)204-8626		(231)733-8686												
H2937	001	0	1	20	08	H2937_001_0	1		1	05/27/2014	2015.01	05/27/2014 01:49:27 PM Eastern Daylight Time		05/22/2014 08:49:25 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Westmoreland county PACE	www.Seniorlifegreensburg.com	Senior LIFE Greensburg Dual Eligible (PACE)	08	20		1			H2937	001	0	2015	Senior LIFE Westmoreland		2	142	2			2								NA	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H2937	002	0	1	20	08	H2937_002_0	1		1	05/27/2014	2015.01	05/27/2014 09:04:53 AM Eastern Daylight Time		05/22/2014 08:49:25 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE GREENSBURG, INC.	Westmoreland county PACE	www.Seniorlifegreensburg.com	Senior LIFE Greensburg MC Only (PACE)	08	20		1			H2937	002	0	2015	Senior LIFE Westmoreland MC Only		2	2	2			2								NA	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H2941	001	0	1	20	08	H2941_001_0	1		1	06/02/2014	2015.01	06/02/2014 08:54:47 AM Eastern Daylight Time		05/28/2014 10:49:17 AM Eastern Daylight Time			06/02/2014 08:56:35 AM Eastern Daylight Time	SENTARA LIFE CARE CORPORATION, INC	Sentara PACE	www.sentara.com	Sentara Senior Community Care Dual (PACE)	08	20		1			H2941	001	0	2015	Chesapeake, Norfolk, Portsmouth, Suffolk, VA Beach		2		2			2								www.sentara.com	www.sentara.com									(800)736-8272		(757)892-5400		(800)736-8272		(757)892-5400										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120												
H2941	002	0	1	20	08	H2941_002_0	1		1	06/02/2014	2015.01	06/02/2014 08:55:08 AM Eastern Daylight Time		05/28/2014 10:56:31 AM Eastern Daylight Time			06/02/2014 08:56:35 AM Eastern Daylight Time	SENTARA LIFE CARE CORPORATION, INC	Sentara PACE	www.sentara.com	Sentara Senior Community Care Private (PACE)	08	20		1			H2941	002	0	2015	Chesapeake, Norfolk, Portsmouth, Suffolk, VA Beach		2		2			2								www.sentara.com	www.sentara.com									(800)736-8272		(757)892-5400		(800)736-8272		(757)892-5400										(800)225-7784		(757)552-7120		(800)225-7784		(757)552-7120												
H2944	004	0	1	09	04	H2944_004_0	4		1	07/10/2014	2015.02	07/10/2014 12:55:08 PM Eastern Daylight Time	08/02/2014 12:41:07 PM Eastern Daylight Time	08/04/2014 05:04:12 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-004 (PFFS)	04	09	3	1			H2944	004	0	2015	Select Counties in Nebraska		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	013	0	1	09	04	H2944_013_0	3		1	07/11/2014	2015.02	07/11/2014 09:02:06 AM Eastern Daylight Time	08/04/2014 02:44:33 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:09:34 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-013 (PFFS)	04	09	3	1			H2944	013	0	2015	Select Counties in AR, KS, MO and OK		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	041	0	1	09	04	H2944_041_0	4		1	07/10/2014	2015.02	07/10/2014 05:15:05 PM Eastern Daylight Time	08/04/2014 10:00:48 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:07:57 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-041 (PFFS)	04	09	3	1			H2944	041	0	2015	Select Counties in Illinois		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	052	0	1	09	04	H2944_052_0	3		1	07/10/2014	2015.02	07/10/2014 12:58:54 PM Eastern Daylight Time	08/02/2014 12:12:11 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-052 (PFFS)	04	09	3	1			H2944	052	0	2015	Select Counties in Montana		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	078	0	1	09	04	H2944_078_0	3		1	07/14/2014	2015.02	07/14/2014 02:06:53 PM Eastern Daylight Time	08/03/2014 06:06:43 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-078 (PFFS)	04	09	3	1			H2944	078	0	2015	Select Counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	085	0	1	09	04	H2944_085_0	3		1	07/11/2014	2015.02	07/11/2014 01:41:30 PM Eastern Daylight Time	08/02/2014 12:41:12 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-085 (PFFS)	04	09	3	1			H2944	085	0	2015	Select Counties in Mississippi		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	114	0	1	09	04	H2944_114_0	6		1	08/06/2014	2015.01	08/06/2014 03:59:42 PM Eastern Daylight Time	08/05/2014 09:37:03 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-114 (PFFS)	04	09	3	1			H2944	114	0	2015	Select Counties in Georgia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	124	0	1	09	04	H2944_124_0	3		1	07/10/2014	2015.02	07/10/2014 01:14:09 PM Eastern Daylight Time	08/05/2014 09:42:26 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 11:43:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-124 (PFFS)	04	09	3	1			H2944	124	0	2015	Select Counties in Indiana		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	127	0	1	09	04	H2944_127_0	5		1	07/10/2014	2015.02	07/10/2014 01:10:22 PM Eastern Daylight Time	08/02/2014 08:06:27 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-127 (PFFS)	04	09	3	1			H2944	127	0	2015	Select Counties in Kentucky		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	133	0	1	09	04	H2944_133_0	4		1	08/06/2014	2015.01	08/06/2014 04:00:43 PM Eastern Daylight Time	08/05/2014 11:14:49 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-133 (PFFS)	04	09	3	1			H2944	133	0	2015	Select Counties in North Carolina		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2944	197	0	1	09	04	H2944_197_0	2		1	07/11/2014	2015.02	07/11/2014 09:01:56 AM Eastern Daylight Time	07/11/2014 07:42:11 PM Eastern Daylight Time				07/14/2014 12:53:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H2944-197 (PFFS)	04	09	3	1			H2944	197	0	2015	Select Counties in AR, KS, MO and OK		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H2949	012	0	1	01	01	H2949_012_0	3		1	08/02/2014	2015.02	08/02/2014 08:24:56 AM Eastern Daylight Time	08/04/2014 05:18:42 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 01:46:12 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H2949-012 (HMO)	01	01		1			H2949	012	0	2015	Clark (partial) and Nye (partial) counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2949	013	0	1	01	01	H2949_013_0	3		1	08/02/2014	2015.02	08/02/2014 08:31:52 AM Eastern Daylight Time	08/04/2014 05:17:07 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 01:46:12 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H2949-013 (HMO SNP)	01	01		1			H2949	013	0	2015	Clark (partial) and Nye (partial) counties		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2949	014	0	1	01	01	H2949_014_0	3		1	08/02/2014	2015.02	08/02/2014 08:37:26 AM Eastern Daylight Time	08/04/2014 05:17:44 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 01:46:12 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CLD H2949-014 (HMO SNP)	01	01		1			H2949	014	0	2015	Clark (partial) and Nye (partial) counties		2		2			1	4		1		00000000000100000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2949	018	0	1	01	01	H2949_018_0	5		1	07/11/2014	2015.02	07/11/2014 01:25:48 PM Eastern Daylight Time		08/04/2014 05:04:13 PM Eastern Daylight Time		08/05/2014 03:33:36 PM Eastern Daylight Time	08/06/2014 01:46:12 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Kidney Care (HMO SNP)	01	01		1			H2949	018	0	2015	Clark (partial) and Nye (partial) counties		2		2			1	4		1		00000000100000000000		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2949	805	0	1	01	01	H2949_805_0	2		1	05/23/2014	2015.02	05/23/2014 02:41:34 PM Eastern Daylight Time	07/14/2014 10:43:48 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2949	805	0	2015	Select counties in Nevada		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2949	807	0	1	01	01	H2949_807_0	2		1	05/23/2014	2015.02	05/23/2014 02:42:18 PM Eastern Daylight Time	07/14/2014 10:54:45 AM Eastern Daylight Time				07/14/2014 01:52:54 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H2949	807	0	2015	Select counties in Nevada		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H2960	004	0	1	01	01	H2960_004_0	7		1	07/23/2014	2015.01	07/23/2014 10:16:54 PM Pacific Daylight Time	08/07/2014 09:38:16 AM Pacific Daylight Time	08/07/2014 09:38:17 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Enhanced Plan (HMO)	01	01		1			H2960	004	0	2015	Washoe County, NV		2	5737	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2960	009	0	1	01	01	H2960_009_0	4		1	07/23/2014	2015.01	07/23/2014 10:36:14 PM Pacific Daylight Time	07/23/2014 01:22:51 PM Pacific Daylight Time				07/24/2014 07:25:58 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Basic Plan (HMO)	01	01		1			H2960	009	0	2015	Washoe County, NV		2	465	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-										2					2					2
H2960	010	0	1	01	01	H2960_010_0	6		1	07/24/2014	2015.01	07/24/2014 07:24:40 PM Pacific Daylight Time	08/07/2014 09:38:18 AM Pacific Daylight Time	08/07/2014 09:38:19 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Premier Plan (HMO)	01	01		1			H2960	010	0	2015	Washoe County, NV		2	792	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2960	012	0	1	01	01	H2960_012_0	6		1	08/06/2014	2015.01	08/06/2014 11:02:40 AM Pacific Daylight Time	08/07/2014 09:38:21 AM Pacific Daylight Time	08/07/2014 09:38:22 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Plan (HMO)	01	01		1			H2960	012	0	2015	Washoe County, NV		2	4952	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2960	018	0	1	01	01	H2960_018_0	6		1	07/23/2014	2015.01	07/23/2014 11:45:49 PM Pacific Daylight Time	08/07/2014 09:38:20 AM Pacific Daylight Time	08/07/2014 09:38:20 AM Pacific Daylight Time			08/07/2014 09:45:52 AM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Rx Select (HMO)	01	01		1			H2960	018	0	2015	Washoe County, NV		2	1445	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2960	803	0	1	01	01	H2960_803_0	2		1	07/23/2014	2015.01	07/23/2014 03:29:28 PM Pacific Daylight Time	07/23/2014 01:23:35 PM Pacific Daylight Time				07/24/2014 07:25:58 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Value Group Plan (HMO)	01	01		1			H2960	803	0	2015	State of Nevada		1	105	2			2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com	(888)775-7003		(775)982-3112		(888)775-7003		(775)982-3158		(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100100110110001111000100	1	011111000100100110110010000	1					1
H2962	001	0	1	01	01	H2962_001_0	12		1	08/06/2014	2015.01	08/06/2014 02:23:18 PM Eastern Daylight Time	08/11/2014 09:21:57 AM Eastern Daylight Time	08/05/2014 09:39:56 AM Eastern Daylight Time			08/15/2014 11:07:55 AM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Premier (HMO)	01	01		1			H2962	001	0	2015	Hernando County		2	3240	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2962	002	0	1	01	01	H2962_002_0	11		1	08/05/2014	2015.01	08/05/2014 09:22:46 PM Eastern Daylight Time	08/05/2014 08:23:48 PM Eastern Daylight Time	08/05/2014 09:40:16 AM Eastern Daylight Time			08/06/2014 03:12:49 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Premier Plus (HMO)	01	01		1			H2962	002	0	2015	Hernando County		2	760	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2962	003	0	1	01	01	H2962_003_0	11		1	08/06/2014	2015.01	08/06/2014 03:09:21 PM Eastern Daylight Time	08/05/2014 08:43:45 PM Eastern Daylight Time	08/05/2014 09:41:48 AM Eastern Daylight Time			08/06/2014 03:12:49 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Elite (HMO)	01	01		1			H2962	003	0	2015	Citrus and Pasco counties		2	1620	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2962	004	0	1	01	01	H2962_004_0	11		1	08/06/2014	2015.01	08/06/2014 02:57:23 PM Eastern Daylight Time	08/05/2014 09:08:53 PM Eastern Daylight Time	08/05/2014 09:42:01 AM Eastern Daylight Time			08/06/2014 03:12:49 PM Eastern Daylight Time	ULTIMATE HEALTH PLANS, INC.	Ultimate Health Plans	www.chooseultimate.com	Ultimate Elite Plus (HMO)	01	01		1			H2962	004	0	2015	Citrus and Pasco counties		2	380	2			2							www.chooseultimate.com	www.chooseultimate.com	www.chooseultimate.com	(888)657-4170		(352)835-7151		(855)858-7526		(352)835-7163		(855)872-0006		(352)835-7151		(855)858-7526		(352)835-7163		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2968	001	0	1	04	01	H2968_001_0	5		1	08/05/2014	2015.02	08/05/2014 04:37:43 PM Central Daylight Time	08/05/2014 05:27:26 PM Central Daylight Time	08/06/2014 12:26:55 PM Central Daylight Time			08/06/2014 05:17:11 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann PPO	healthplan.memorialhermann.org	Memorial Hermann Advantage (PPO)	01	04		1			H2968	001	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		2		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764		(888)971-1377		(713)338-6764		(888)897-1337		(713)338-6764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H2968	801	0	1	04	01	H2968_801_0	3		1	05/30/2014	2015.02	05/30/2014 05:30:49 PM Central Daylight Time	07/15/2014 04:45:10 PM Central Daylight Time				07/17/2014 10:56:54 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann PPO	healthplan.memorialhermann.org	Memorial Hermann Advantage (PPO)	01	04		1			H2968	801	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764		(888)971-1377		(713)338-6764		(888)897-1337		(713)338-6764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011001011000000100001100000000	2		1					
H2968	802	0	1	04	01	H2968_802_0	3		1	05/30/2014	2015.02	05/30/2014 04:41:48 PM Central Daylight Time	07/15/2014 04:46:09 PM Central Daylight Time				07/17/2014 10:56:54 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann PPO	healthplan.memorialhermann.org	Memorial Hermann Advantage (PPO)	01	04		1			H2968	802	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764		(888)971-1377		(713)338-6764		(888)897-1337		(713)338-6764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011001011000000010001100000000	2		1					
H2968	803	0	1	04	01	H2968_803_0	3		1	06/01/2014	2015.02	06/01/2014 06:19:01 PM Central Daylight Time	07/15/2014 04:47:10 PM Central Daylight Time				07/17/2014 10:56:54 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann PPO	healthplan.memorialhermann.org	Memorial Hermann Advantage (PPO)	01	04		1			H2968	803	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764										(711)-		(711)-		(711)-		(711)-										1	1	011100011001011000000100001100000000	2		1					
H2986	001	0	1	01	01	H2986_001_0	7		1	08/13/2014	2015.01	08/13/2014 09:52:45 AM Pacific Daylight Time	08/13/2014 09:49:13 AM Pacific Daylight Time	08/13/2014 09:49:13 AM Pacific Daylight Time			08/13/2014 09:54:04 AM Pacific Daylight Time	UNIVERSITY HEALTHCARE ADVANTAGE	University HealthCare Advantage	http://uhca.stanfordhospital.org/	University HealthCare Advantage (HMO)	01	01		1			H2986	001	0	2015	University HealthCare Advantage		2	2000	2			2								http://uhca.stanfordhospital.org	http://uhca.stanfordhospital.org	(855)966-8422		(855)966-8422		(855)966-8422		(855)966-8422		(855)966-8422		(855)966-8422		(855)966-8422		(855)966-8422		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H2992	001	0	1	20	08	H2992_001_0	1		1	05/27/2014	2015.01	05/27/2014 09:10:41 AM Eastern Daylight Time		05/22/2014 08:50:33 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifewashington.com	Senior Life Washington Dual Eligible (PACE)	08	20		1			H2992	001	0	2015	Senior LIFE Washington Greene County Dual Eligible		2	210	2			2								None	None									(877)998-5433		(724)222-5433		(877)998-5433		(724)222-5433										(877)998-5433		(724)222-5433		(877)998-5433		(724)222-5433												
H2992	002	0	1	20	08	H2992_002_0	1		1	05/27/2014	2015.01	05/27/2014 09:10:56 AM Eastern Daylight Time		05/22/2014 08:50:33 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifewashington.com	Senior Life Washington Medicare Only (PACE)	08	20		1			H2992	002	0	2015	Senior LIFE Washington Greene County Medicare Only		2	4	2			2								None	None									(877)998-5433		(724)222-5433		(877)998-5433		(724)222-5433										(877)998-5433		(724)222-5433		(877)998-5433		(724)222-5433												
H2992	003	0	1	20	08	H2992_003_0	1		1	05/27/2014	2015.01	05/27/2014 09:09:36 AM Eastern Daylight Time		05/22/2014 08:49:33 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifeuniontown.com	Senior LIFE Uniontown Dual Eligible (PACE)	08	20		1			H2992	003	0	2015	Senior LIFE Uniontown Greene County Dual Eligible		2	210	2			2								None	None									(877)998-5433		(724)434-5433		(877)998-5433		(724)434-5433										(877)998-5433		(724)434-5433		(877)998-5433		(724)434-5433												
H2992	004	0	1	20	08	H2992_004_0	1		1	05/27/2014	2015.01	05/27/2014 09:09:51 AM Eastern Daylight Time		05/22/2014 08:49:34 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIORLIFE WASHINGTON, INC.	Senior LIFE Washington / Uniontown / Green	www.seniorlifeuniontown.com	Senior Life Uniontown Medicare Only (PACE)	08	20		1			H2992	004	0	2015	Senior LIFE Uniontown Greene County Medicare Only		2	4	2			2								None	None									(877)998-5433		(724)434-5433		(877)998-5433		(724)434-5433										(877)998-5433		(724)434-5433		(877)998-5433		(724)434-5433												
H3018	001	0	1	48	05	H3018_001_0	4		1	08/29/2014	2015.01	08/29/2014 10:51:18 AM Eastern Daylight Time					08/29/2014 10:52:23 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	FIDA Care Complete (Medicare-Medicaid Plan)	05	48		1			H3018	001	0	2015	Kings,Queens,Bronx,New York and Richmond Counties		2		2			2							www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3054	001	0	1	01	01	H3054_001_0	8	1	1	08/06/2014	2015.01	08/06/2014 09:32:29 AM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time			08/06/2014 01:59:52 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Genesis - Constellation Health (HMO SNP)	01	01		1			H3054	001	0	2015	Puerto Rico		2	16226	2		1	1	3		1	3		1	www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2
H3060	001	0	1	20	08	H3060_001_0	1		1	06/02/2014	2015.01	06/02/2014 05:18:29 PM Eastern Daylight Time		06/02/2014 02:35:09 PM Eastern Daylight Time			06/02/2014 06:03:49 PM Eastern Daylight Time	VIECARE BEAVER LLC DBA LIFE BEAVER COUNTY	LIFE Butler County	www.lutheranseniorlife.org	VIECARE BUTLER LLC DBA LIFE BUTLER COUNTY (PACE)	08	20		1			H3060	001	0	2015	LIFE Butler		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(800)000-0000		(724)742-2226		(800)000-0000		(724)742-2226										(800)000-0000		(724)742-2226		(800)000-0000		(724)742-2226												
H3060	002	0	1	20	08	H3060_002_0	1		1	06/02/2014	2015.01	06/02/2014 05:19:00 PM Eastern Daylight Time		06/02/2014 02:40:16 PM Eastern Daylight Time			06/02/2014 06:03:49 PM Eastern Daylight Time	VIECARE BEAVER LLC DBA LIFE BEAVER COUNTY	LIFE Butler County	www.lutheranseniorlife.org	VIECARE BUTLER LLC DBA LIFE BUTLER COUNTY (PACE)	08	20		1			H3060	002	0	2015	LIFE Butler		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(800)000-0000		(724)742-2226		(800)000-0000		(724)742-2226										(800)000-0000		(724)742-2226		(800)000-0000		(724)742-2226												
H3067	001	0	1	48	05	H3067_001_0	5		1	08/05/2014	2015.01	08/05/2014 11:17:06 AM Eastern Daylight Time					08/05/2014 11:18:00 AM Eastern Daylight Time	VIRGINIA PREMIER HEALTH PLAN, INC.	Virginia Premier CompleteCare	www.vapremier.com	Virginia Premier Health Plan, Inc. (Medicare-Medicaid Plan)	05	48		1			H3067	001	0	2015	Central, Tidewater, Northern, Western, Roanoke		2		2			2							www.vapremier.com	www.vapremier.com	www.vapremier.com	(800)727-7536		(804)819-5151		(800)727-7536		(804)819-5151		(800)727-7536		(804)819-5151		(800)727-7536		(804)819-5151		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		(800)828-1120		2					2					2
H3071	001	0	1	01	01	H3071_001_0	12	2	1	08/07/2014	2015.01	08/07/2014 10:59:10 PM Central Daylight Time	08/13/2014 11:59:17 AM Central Daylight Time	08/13/2014 01:04:22 PM Central Daylight Time			08/13/2014 01:24:53 PM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP	Community Care Alliance of Illinois, NFP	https://www.ccaillinois.com	Community Care Alliance of Illinois, NFP (HMO SNP)	01	01		1			H3071	001	0	2015	Rockford Area, Chicago Area		2	1110	2			1	3		1	3		2	https://www.ccaillinois.com	https://www.ccaillinois.com	www.cvs.com	(866)871-2305		(866)871-2305		(866)871-2305		(866)871-2305		(888)232-8479		(888)232-8479		(888)232-8479		(888)232-8479		(888)461-2378		(888)461-2378		(888)461-2378		(888)461-2378		(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069		2					2					2
H3071	002	0	1	01	01	H3071_002_0	8		1	08/06/2014	2015.01	08/06/2014 07:29:56 PM Central Daylight Time	08/05/2014 12:46:09 PM Central Daylight Time	07/31/2014 03:47:51 PM Central Daylight Time			08/06/2014 08:03:42 PM Central Daylight Time	COMMUNITY CARE ALLIANCE OF ILLINOIS, NFP	Community Care Alliance of Illinois, NFP	https://www.ccaillinois.com	Community Care Alliance of Illinois (HMO)	01	01		1			H3071	002	0	2015	Rockford Area, Chicago Area		2	768	2			2							https://www.ccaillinois.com	https://www.ccaillinois.com	www.cvs.com	(866)871-2305		(866)871-2305		(866)871-2305		(866)871-2305		(888)232-8479		(888)232-8479		(888)232-8479		(888)232-8479		(888)461-2378		(888)461-2378		(888)461-2378		(888)461-2378		(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069		2					2					2
H3107	004	0	1	01	01	H3107_004_0	2		1	05/30/2014	2015.01	05/30/2014 04:30:04 PM Central Daylight Time	08/04/2014 02:39:38 PM Central Daylight Time	07/31/2014 03:21:40 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3107	004	0	2015	Northern and Central New Jersey		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3107	008	0	1	01	01	H3107_008_0	1		1	05/29/2014	2015.01	05/29/2014 08:35:07 AM Central Daylight Time	05/30/2014 05:10:25 PM Central Daylight Time				05/31/2014 10:29:26 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3107	008	0	2015	Northern and Central New Jersey		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H3107	012	0	1	01	01	H3107_012_0	2		1	05/30/2014	2015.01	05/30/2014 04:30:21 PM Central Daylight Time	08/04/2014 02:41:07 PM Central Daylight Time	07/31/2014 03:21:44 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3107	012	0	2015	Essex and Ocean County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3107	013	0	1	01	01	H3107_013_0	2		1	05/30/2014	2015.01	05/30/2014 04:30:39 PM Central Daylight Time	08/04/2014 02:41:54 PM Central Daylight Time	07/31/2014 03:21:49 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	UnitedHealthcare Barnabas MedicareComplete (HMO)	01	01		1			H3107	013	0	2015	Northern and Central New Jersey		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3107	014	0	1	01	01	H3107_014_0	2		1	05/30/2014	2015.01	05/30/2014 04:31:05 PM Central Daylight Time	08/04/2014 02:43:54 PM Central Daylight Time	07/31/2014 03:21:53 PM Central Daylight Time			08/06/2014 09:43:40 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H3107	014	0	2015	Northern and Central New Jersey		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3107	801	0	1	01	01	H3107_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:09:44 AM Central Daylight Time	05/30/2014 05:12:34 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3107	801	0	2015	State of New Jersey Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3107	803	0	1	01	01	H3107_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:09:50 AM Central Daylight Time	05/30/2014 05:13:06 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3107	803	0	2015	State of New Jersey Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H3107	804	0	1	01	01	H3107_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:10:01 AM Central Daylight Time	05/30/2014 05:13:39 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3107	804	0	2015	Morris NJ		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3113	001	0	1	01	01	H3113_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:26:38 AM Central Daylight Time	08/12/2014 09:38:24 AM Central Daylight Time	07/31/2014 03:21:56 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3113	001	0	2015	Northern and Central New Jersey		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3113	005	0	1	01	01	H3113_005_0	3	2	1	08/04/2014	2015.02	08/04/2014 05:39:27 PM Central Daylight Time	08/04/2014 04:12:02 PM Central Daylight Time	07/31/2014 03:24:06 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete ONE (HMO SNP)	01	01		1			H3113	005	0	2015	Essex,Middlesex,Monmouth,Ocean and Union counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(855)873-3482		(855)873-3482		(888)834-3721		(888)834-3721		(855)873-3482		(855)873-3482		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3113	007	0	1	01	01	H3113_007_0	5		1	08/04/2014	2015.02	08/04/2014 05:49:29 PM Central Daylight Time	08/12/2014 09:39:46 AM Central Daylight Time	07/31/2014 03:24:11 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3113	007	0	2015	St. Louis and St. Louis City counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3113	008	0	1	01	01	H3113_008_0	3		1	07/18/2014	2015.02	07/18/2014 09:27:01 AM Central Daylight Time	08/04/2014 04:12:53 PM Central Daylight Time	07/31/2014 03:24:16 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	OXFORD HEALTH PLANS (NJ), INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO SNP)	01	01		1			H3113	008	0	2015	Clackamas, Lane, Multnomah,and Washington counties		2		2			1	1	2	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3129	001	0	1	48	05	H3129_001_0	4		1	08/12/2014	2015.01	08/12/2014 12:37:26 PM Eastern Daylight Time					08/12/2014 01:50:30 PM Eastern Daylight Time	NORTH SHORE-LIJ HEALTH PLAN, INC.	North Shore-LIJ Health Plan, Inc.	www.nslijhealthplans.com/fidalivewell	North Shore-LIJ FIDA LiveWell (Medicare-Medicaid Plan)	05	48		1			H3129	001	0	2015	NASSAU QUEENS RICHMOND COUNTIES		2	1100	2			2								www.nslijhealthplans.com/fidalivewell	www.nslijhealthplans.com/fidalivewell	(855)776-7545		(855)776-7545		(855)786-7545		(855)786-7545		(855)776-7545		(855)776-7545		(855)786-7545		(855)786-7545		(711)-		(711)-		(711)-		(711)-		(866)236-1069		(711)-		(711)-		(711)-		2					2					2
H3132	001	0	1	01	01	H3132_001_0	8		1	08/05/2014	2015.01	08/05/2014 03:10:29 PM Pacific Daylight Time	08/12/2014 10:03:14 AM Pacific Daylight Time	08/05/2014 03:01:47 PM Pacific Daylight Time			08/12/2014 10:03:55 AM Pacific Daylight Time	AHF MCO OF FLORIDA, INC.	AHF	www.php-fl.org	PHP (HMO SNP)	01	01		1			H3132	001	0	2015	Broward, Miami-Dade and Duval Counties, Florida		2	1193	2			1	4		1		00000000001000000000		www.php-fl.org/consider-php/provider-pharmacy-networks	www.php-fl.org/for-members/drug-benefit/formulary	www.php-fl.org/consider-php/provider-pharmacy-networks	(888)456-4715		(888)456-4715		(888)456-4715		(888)456-4715		(866)763-9096		(866)763-9096		(888)456-4715		(888)456-4715		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3152	022	0	1	01	01	H3152_022_0	5		1	08/03/2014	2015.01	08/03/2014 10:51:35 AM Eastern Daylight Time	08/05/2014 09:52:34 AM Eastern Daylight Time	08/01/2014 09:29:19 AM Eastern Daylight Time			08/05/2014 04:08:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3152	022	0	2015	Southern NJ		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3152	045	0	1	01	01	H3152_045_0	3		1	06/27/2014	2015.01	06/27/2014 02:23:55 PM Eastern Daylight Time	05/28/2014 08:24:30 PM Eastern Daylight Time				07/13/2014 09:35:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3152	045	0	2015	Northern NJ		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					2					2
H3152	046	0	1	01	01	H3152_046_0	5		1	08/03/2014	2015.01	08/03/2014 11:08:17 AM Eastern Daylight Time	08/05/2014 09:52:54 AM Eastern Daylight Time	08/01/2014 09:29:29 AM Eastern Daylight Time			08/05/2014 04:08:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3152	046	0	2015	Northern New Jersey		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3152	048	0	1	01	01	H3152_048_0	7		1	07/21/2014	2015.01	07/21/2014 07:29:21 PM Eastern Daylight Time	08/05/2014 09:42:30 AM Eastern Daylight Time	08/01/2014 09:29:40 AM Eastern Daylight Time			08/05/2014 04:08:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3152	048	0	2015	Northern New Jersey		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3152	077	0	1	01	01	H3152_077_0	4		1	07/17/2014	2015.01	07/17/2014 01:46:06 PM Eastern Daylight Time	08/05/2014 09:53:32 AM Eastern Daylight Time	08/01/2014 09:37:28 AM Eastern Daylight Time			08/05/2014 04:08:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3152	077	0	2015	Camden, Gloucester and Mercer counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3152	080	0	1	01	01	H3152_080_0	5		1	08/03/2014	2015.01	08/03/2014 11:15:43 AM Eastern Daylight Time	08/05/2014 09:53:52 AM Eastern Daylight Time	08/01/2014 09:37:38 AM Eastern Daylight Time			08/05/2014 04:08:48 PM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare NNJ Prime Plan (HMO)	01	01		1			H3152	080	0	2015	Northern New Jersey		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3152	801	0	1	01	01	H3152_801_0	2		1	05/20/2014	2015.01	05/20/2014 09:44:22 AM Eastern Daylight Time	07/10/2014 02:43:42 PM Eastern Daylight Time				07/21/2014 11:50:14 AM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3152	801	0	2015	New Jersey		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H3152	804	0	1	01	01	H3152_804_0	2		1	05/20/2014	2015.01	05/20/2014 09:47:15 AM Eastern Daylight Time	07/10/2014 02:46:30 PM Eastern Daylight Time				07/21/2014 11:50:14 AM Eastern Daylight Time	AETNA HEALTH, INC. (NJ)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3152	804	0	2015	New Jersey		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H3154	004	0	1	01	01	H3154_004_0	8		1	07/09/2014	2015.02	07/09/2014 02:51:14 PM Eastern Daylight Time	08/06/2014 11:07:49 AM Eastern Daylight Time	08/06/2014 11:07:06 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.HorizonBlue.com/medicare	Horizon Medicare Blue Value w/ Rx (HMO)	01	01		1			H3154	004	0	2015	Counties:  CPM, ESX, HUD, OCN, SLM, UNN, WRN		2	7128	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	013	0	1	01	01	H3154_013_0	6		1	07/09/2014	2015.02	07/09/2014 02:53:00 PM Eastern Daylight Time	07/10/2014 10:35:16 AM Eastern Daylight Time				07/10/2014 11:07:21 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.HorizonBlue.com/medicare	Horizon Medicare Blue Value (HMO)	01	01		1			H3154	013	0	2015	Counties:  CPM, ESX, HUD, OCN, SLM, UNN, WRN		2	792	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234										(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899										2					2					2
H3154	022	0	1	01	01	H3154_022_0	10		1	07/09/2014	2015.02	07/09/2014 02:51:54 PM Eastern Daylight Time	08/06/2014 11:09:25 AM Eastern Daylight Time	08/06/2014 11:08:29 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.HorizonBlue.com/medicare	Horizon Medicare Blue Choice w/Rx (HMO)	01	01		1			H3154	022	0	2015	14 Counties Throughout New Jersey		2	9532	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	024	0	1	01	01	H3154_024_0	7		1	08/05/2014	2015.02	08/05/2014 11:51:50 AM Eastern Daylight Time	08/06/2014 11:10:55 AM Eastern Daylight Time	08/06/2014 11:10:14 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	024	0	2015	Essex, Hudson, Ocean, Salem, and Warren Counties		2	4326	2			2							http://directory.horizonblue.com/	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	026	0	1	01	01	H3154_026_0	7		1	07/09/2014	2015.02	07/09/2014 02:47:18 PM Eastern Daylight Time	08/06/2014 11:14:26 AM Eastern Daylight Time	08/06/2014 11:13:16 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	026	0	2015	Middlesex, Morris, Sussex, and Union Counties		2	2124	2			2							http://directory.horizonblue.com/	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	027	0	1	01	01	H3154_027_0	8		1	07/09/2014	2015.02	07/09/2014 02:47:47 PM Eastern Daylight Time	08/06/2014 11:18:42 AM Eastern Daylight Time	08/06/2014 11:17:22 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	027	0	2015	Counties: BRG, CPM, MRR, MMT, PSC, SMS		2	802	2			2							http://directory.horizonblue.com/	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	028	0	1	01	01	H3154_028_0	7		1	07/09/2014	2015.02	07/09/2014 02:48:20 PM Eastern Daylight Time	08/06/2014 11:21:41 AM Eastern Daylight Time	08/06/2014 11:19:51 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Patient-Centered w/Rx (HMO)	01	01		1			H3154	028	0	2015	Counties: ATL, CMD, CMN, GLC, HNT		2	555	2			2							http://directory.horizonblue.com/	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	801	0	1	02	01	H3154_801_0	4		1	05/30/2014	2015.02	05/30/2014 08:25:51 AM Eastern Daylight Time	06/02/2014 02:01:56 PM Eastern Daylight Time				06/02/2014 02:15:48 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Access Group (HMO-POS)	01	02		1			H3154	801	0	2015	New Jersey		1	951	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)328-4542		(888)328-4542										(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899										2					2					2
H3154	802	0	1	02	01	H3154_802_0	5		1	05/30/2014	2015.02	05/30/2014 10:22:29 AM Eastern Daylight Time	06/02/2014 04:04:17 PM Eastern Daylight Time				06/02/2014 04:06:09 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Access Grp w/ Rx (HMO-POS)	01	02		1			H3154	802	0	2015	New Jersey		1	1692	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)328-4542		(888)328-4542		(800)391-1906		(800)391-1906		(888)328-4542		(888)328-4542		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3154	805	0	1	02	01	H3154_805_0	4		1	05/30/2014	2015.02	05/30/2014 10:29:02 AM Eastern Daylight Time	06/02/2014 02:03:41 PM Eastern Daylight Time				06/02/2014 02:15:48 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/Medicare	Horizon Medicare Blue Access Grp w/ Rx (HMO-POS)	01	02		1			H3154	805	0	2015	New Jersey		1	20	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	https://medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)328-4542		(888)328-4542		(800)391-1906		(800)391-1906		(888)328-4542		(888)328-4542		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					2
H3156	029	0	1	01	01	H3156_029_0	2		1	06/11/2014	2015.01	06/11/2014 05:16:01 PM Eastern Daylight Time	06/20/2014 04:59:24 PM Eastern Daylight Time				06/24/2014 02:18:03 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Medical Only (HMO)	01	01		1			H3156	029	0	2015	Counties: BR CM CU EX GL HD HN MX MR OC SL SM UN		2	1000	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										2					2					2
H3156	030	0	1	01	01	H3156_030_0	3		1	05/28/2014	2015.01	05/28/2014 09:11:21 AM Eastern Daylight Time	08/05/2014 12:30:45 PM Eastern Daylight Time	08/05/2014 12:30:24 PM Eastern Daylight Time			08/06/2014 08:16:08 AM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Rx (HMO)	01	01		1			H3156	030	0	2015	Counties: BR CM CU EX GL HD HN MX MR OC SL SM UN		2	10000	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3156	033	0	1	01	01	H3156_033_0	2		1	05/27/2014	2015.01	05/27/2014 08:09:11 AM Eastern Daylight Time	06/20/2014 04:59:40 PM Eastern Daylight Time				06/24/2014 02:18:03 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Medical Only (HMO)	01	01		1			H3156	033	0	2015	Counties: BG, CP, MN, MS, PS, SX, WR		2	5000	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										2					2					2
H3156	034	0	1	01	01	H3156_034_0	3		1	05/28/2014	2015.01	05/28/2014 09:11:51 AM Eastern Daylight Time	08/05/2014 12:30:03 PM Eastern Daylight Time	08/05/2014 12:29:31 PM Eastern Daylight Time			08/06/2014 08:16:08 AM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Rx (HMO)	01	01		1			H3156	034	0	2015	Counties: BG, CP, MN, MS, PS, SX, WR		2	5000	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3156	035	0	1	01	01	H3156_035_0	2		1	05/27/2014	2015.01	05/27/2014 08:09:44 AM Eastern Daylight Time	06/20/2014 04:59:56 PM Eastern Daylight Time				06/24/2014 02:18:03 PM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Medical Only (HMO)	01	01		1			H3156	035	0	2015	County: Atlantic		2	500	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										2					2					2
H3156	036	0	1	01	01	H3156_036_0	3		1	05/28/2014	2015.01	05/28/2014 09:12:25 AM Eastern Daylight Time	08/05/2014 12:28:21 PM Eastern Daylight Time	08/05/2014 12:31:08 PM Eastern Daylight Time			08/06/2014 08:16:08 AM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 Preferred Rx (HMO)	01	01		1			H3156	036	0	2015	County: Atlantic		2	500	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3156	801	0	1	01	01	H3156_801_0	3		1	05/28/2014	2015.01	05/28/2014 12:41:44 PM Eastern Daylight Time	06/04/2014 02:37:33 PM Eastern Daylight Time				06/10/2014 09:34:51 AM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 NJ Group Medical Only (HMO)	01	01		1			H3156	801	0	2015	State of New Jersey		1	2000	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492										(711)-		(711)-		(711)-		(711)-										1	1	011100011000000000111110011110000100	1	100000111011010111000000001	1					1
H3156	803	0	1	01	01	H3156_803_0	1		1	05/28/2014	2015.01	05/28/2014 12:41:59 PM Eastern Daylight Time	06/02/2014 11:49:51 AM Eastern Daylight Time				06/02/2014 11:54:18 AM Eastern Daylight Time	AMERIHEALTH HMO, INC.	AmeriHealth 65 Preferred HMO	www.amerihealthmedicare.com	AmeriHealth 65 NJ Group Rx (HMO)	01	01		1			H3156	803	0	2015	State of New Jersey		1	500	2			2							www.amerihealthmedicare.com	www.amerihealthmedicare.com	www.amerihealthmedicare.com	(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(866)569-5190		(866)569-5190		(800)898-3492		(800)898-3492		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011000000000111110011110000100	1	100000111011010111000000001	1					1
H3204	001	0	1	01	01	H3204_001_0	8		1	08/06/2014	2015.01	08/06/2014 02:54:40 PM Mountain Daylight Time	08/01/2014 01:35:02 PM Mountain Daylight Time	07/31/2014 03:27:53 PM Mountain Daylight Time			08/06/2014 03:02:39 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 2 with Rx (HMO)	01	01		1			H3204	001	0	2015	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	18605	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		2					2					2
H3204	007	0	1	01	01	H3204_007_0	7		1	07/22/2014	2015.01	07/22/2014 09:54:42 AM Mountain Daylight Time	08/01/2014 01:35:52 PM Mountain Daylight Time	07/31/2014 03:27:57 PM Mountain Daylight Time			08/06/2014 03:02:39 PM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 3 with Rx (HMO)	01	01		1			H3204	007	0	2015	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	5476	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		2					2					2
H3204	008	0	1	01	01	H3204_008_0	5		1	07/22/2014	2015.01	07/22/2014 09:54:56 AM Mountain Daylight Time	07/16/2014 09:41:16 AM Mountain Daylight Time				07/22/2014 10:24:20 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Plan 1 (HMO)	01	01		1			H3204	008	0	2015	Greater Albuquerque Area, Rio Arriba and Santa Fe		2	252	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429										2					2					2
H3204	801	0	1	01	01	H3204_801_0	5		1	06/01/2014	2015.01	06/01/2014 03:49:43 PM Mountain Daylight Time	07/16/2014 09:41:13 AM Mountain Daylight Time				07/16/2014 10:33:35 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 with Rx (HMO)	01	01		1			H3204	801	0	2015	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	252	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		1	2		2		1					1
H3204	802	0	1	01	01	H3204_802_0	4		1	06/01/2014	2015.01	06/01/2014 03:46:31 PM Mountain Daylight Time	07/16/2014 09:42:34 AM Mountain Daylight Time				07/16/2014 10:35:46 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 1 (HMO)	01	01		1			H3204	802	0	2015	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429										1	2		2		1					1
H3204	803	0	1	01	01	H3204_803_0	4		1	06/06/2014	2015.01	06/06/2014 05:04:39 PM Mountain Daylight Time	07/16/2014 09:42:35 AM Mountain Daylight Time				07/16/2014 10:38:40 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Pres Senior Care Emp Group Plan 2 w/ Rx NC (HMO)	01	01		1			H3204	803	0	2015	Greater Albuquerque Area, Rio Arriba and Santa Fe		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		1	2		2		1					1
H3204	808	0	1	02	01	H3204_808_0	4		1	06/01/2014	2015.01	06/01/2014 03:56:20 PM Mountain Daylight Time	07/16/2014 09:43:32 AM Mountain Daylight Time				07/16/2014 10:46:26 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	01	02		1			H3204	808	0	2015	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		2					2					2
H3204	809	0	1	02	01	H3204_809_0	4		1	06/01/2014	2015.01	06/01/2014 04:08:14 PM Mountain Daylight Time	07/16/2014 09:43:33 AM Mountain Daylight Time				07/16/2014 10:48:28 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 6 (HMO-POS)	01	02		1			H3204	809	0	2015	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429										2					2					2
H3204	810	0	1	02	01	H3204_810_0	4		1	06/01/2014	2015.01	06/01/2014 03:48:03 PM Mountain Daylight Time	07/16/2014 09:43:29 AM Mountain Daylight Time				07/16/2014 10:50:40 AM Mountain Daylight Time	PRESBYTERIAN HEALTH PLAN	Presbyterian Senior Care (HMO)	http://www.phs.org/Medicare	Presbyterian Senior Care Emp Group Plan 5 (HMO-POS)	01	02		1			H3204	810	0	2015	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		2					2					2
H3206	001	0	1	04	01	H3206_001_0	6		1	07/22/2014	2015.01	07/22/2014 09:55:43 AM Mountain Daylight Time	08/01/2014 01:36:16 PM Mountain Daylight Time	07/31/2014 03:28:10 PM Mountain Daylight Time			08/04/2014 08:48:48 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 2 with Rx (PPO)	01	04		1			H3206	001	0	2015	State of New Mexico		2	3267	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		2					2					
H3206	002	0	1	04	01	H3206_002_0	6		1	07/22/2014	2015.01	07/22/2014 09:55:54 AM Mountain Daylight Time	08/01/2014 01:36:36 PM Mountain Daylight Time	07/31/2014 03:28:15 PM Mountain Daylight Time			08/04/2014 08:48:48 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 3 with Rx (PPO)	01	04		1			H3206	002	0	2015	State of New Mexico		2	1433	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		2					2					
H3206	003	0	1	04	01	H3206_003_0	5		1	07/22/2014	2015.01	07/22/2014 09:56:05 AM Mountain Daylight Time	07/16/2014 09:43:56 AM Mountain Daylight Time				07/22/2014 10:24:20 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Presbyterian MediCare PPO Plan 1 (PPO)	01	04		1			H3206	003	0	2015	State of New Mexico		2	387	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429										2					2					
H3206	801	0	1	04	01	H3206_801_0	4		1	06/01/2014	2015.01	06/01/2014 03:48:46 PM Mountain Daylight Time	07/16/2014 09:43:51 AM Mountain Daylight Time				07/16/2014 11:06:25 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Pres MediCare PPO Emp Group Plan 2 with Rx (PPO)	01	04		1			H3206	801	0	2015	State of New Mexico		1	8978	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		1	2		2		1					
H3206	802	0	1	04	01	H3206_802_0	4		1	06/01/2014	2015.01	06/01/2014 03:48:50 PM Mountain Daylight Time	07/16/2014 09:44:32 AM Mountain Daylight Time				07/16/2014 11:08:30 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Pres Medicare PPO Employer Group Plan 1 (PPO)	01	04		1			H3206	802	0	2015	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458										(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429										1	2		2		1					
H3206	803	0	1	04	01	H3206_803_0	4		1	06/01/2014	2015.01	06/01/2014 03:48:54 PM Mountain Daylight Time	07/16/2014 09:44:31 AM Mountain Daylight Time				07/16/2014 11:10:18 AM Mountain Daylight Time	PRESBYTERIAN INSURANCE COMPANY, INC.	Presbyterian MediCare PPO	http://www.phs.org/Medicare	Pres MediCare PPO Empl Group Plan 2 +Rx NC (PPO)	01	04		1			H3206	803	0	2015	State of New Mexico		1	1	2			2								http://www.phs.org/Medicare	www.phs.org/Medicare	(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(800)797-5343		(505)923-6060		(800)347-4766		(505)923-8458		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		(888)625-8818		(888)625-8818		(888)625-6429		(888)625-6429		1	2		2		1					
H3209	001	0	1	04	01	H3209_001_0	5		1	08/04/2014	2015.02	08/04/2014 05:51:52 PM Central Daylight Time	08/04/2014 05:43:09 PM Central Daylight Time	07/31/2014 03:24:21 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H3209	001	0	2015	Bernalillo county		2		2			1	1	1	1					www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3209	002	0	1	04	01	H3209_002_0	3	2	1	08/04/2014	2015.02	08/04/2014 05:51:45 PM Central Daylight Time	08/04/2014 04:15:34 PM Central Daylight Time	07/31/2014 03:24:26 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H3209	002	0	2015	Bernalillo, Sandoval, Santa Fe, Valencia Counties		2		2			1	3		1	2				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3233	001	0	1	01	01	H3233_001_0	4		1	08/05/2014	2015.01	08/05/2014 07:09:43 PM Eastern Daylight Time	08/05/2014 07:08:26 PM Eastern Daylight Time	08/05/2014 07:08:26 PM Eastern Daylight Time			08/06/2014 07:43:18 AM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Insuring Corporation	premierhealthplan.com	Premier Health Advantage (HMO)	01	01		1			H3233	001	0	2015	Dayton Metro		2	1600	2			2							premierhealthplan.com	premierhealthplan.com	premierhealthplan.com	(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		2					2					2
H3233	002	0	1	01	01	H3233_002_0	6	2	1	08/05/2014	2015.01	08/05/2014 07:09:34 PM Eastern Daylight Time	08/05/2014 07:08:27 PM Eastern Daylight Time	08/08/2014 01:52:46 PM Eastern Daylight Time			08/08/2014 01:53:45 PM Eastern Daylight Time	PREMIER HEALTH INSURING CORPORATION	Premier Health Insuring Corporation	premierhealthplan.com	Premier Health Advantage VIP (HMO SNP)	01	01		1			H3233	002	0	2015	Dayton Metro		2	250	2			1	3		1	3		2	premierhealthplan.com	premierhealthplan.com	premierhealthplan.com	(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)869-7139		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		2					2					2
H3237	001	0	1	48	05	H3237_001_0	2		1	07/02/2014	2015.01	07/02/2014 05:43:14 PM Pacific Daylight Time					07/03/2014 09:25:48 AM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/medicare	Health Net Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H3237	001	0	2015	Los Angeles County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(855)464-3571		(855)464-3571		(888)788-5395		(888)788-5395		(855)464-3571		(855)464-3571		(888)788-5395		(888)788-5395		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3237	002	0	1	48	05	H3237_002_0	2		1	07/02/2014	2015.01	07/02/2014 08:00:33 PM Pacific Daylight Time					07/03/2014 09:25:48 AM Pacific Daylight Time	HEALTH NET COMMUNITY SOLUTIONS, INC.	Health Net Cal MediConnect Medicare Medicaid Plan	www.healthnet.com/medicare	Health Net Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H3237	002	0	2015	San Diego County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(855)464-3571		(855)464-3571		(888)788-5805		(888)788-5805		(855)464-3571		(855)464-3571		(888)788-5805		(888)788-5805		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3240	013	0	1	01	01	H3240_013_0	10	2	1	07/15/2014	2015.01	07/15/2014 02:26:52 PM Eastern Daylight Time	08/06/2014 02:20:11 PM Eastern Daylight Time	08/06/2014 04:05:01 PM Eastern Daylight Time			08/06/2014 04:32:52 PM Eastern Daylight Time	AMERIGROUP NEW JERSEY, INC.	Amerigroup Community Care	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H3240	013	0	2015	Eastern / Central New Jersey		2	5219	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H3251	002	0	1	01	01	H3251_002_0	9		1	07/17/2014	2015.01	07/17/2014 03:28:50 PM Central Daylight Time	08/05/2014 04:52:56 PM Central Daylight Time	08/05/2014 04:55:29 PM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Lovelace Medicare Plan provided by BCBSNM	www.mylovelacemedicarenm.com	Lovelace Medicare Plan $0 provided by BCBSNM (HMO)	01	01		1			H3251	002	0	2015	Greater New Mexico Area		2	16096	2			2							www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3251	021	0	1	02	01	H3251_021_0	10		1	07/17/2014	2015.01	07/17/2014 03:29:17 PM Central Daylight Time	08/05/2014 04:54:16 PM Central Daylight Time	08/05/2014 04:54:35 PM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Lovelace Medicare Plan provided by BCBSNM	www.mylovelacemedicarenm.com	Lovelace Medicare Plan Enhanced provided by BCBSNM (HMO-POS)	01	02		1			H3251	021	0	2015	Greater New Mexico Area		2	2088	2			2							www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3251	804	0	1	01	01	H3251_804_0	4		1	06/30/2014	2015.01	06/30/2014 03:20:33 PM Central Daylight Time	07/17/2014 08:47:30 AM Central Daylight Time				07/17/2014 12:15:25 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Lovelace Medicare Plan provided by BCBSNM	www.mylovelacemedicarenm.com	Lovelace Employer Group Medicare Plan (HMO)	01	01		1			H3251	804	0	2015	New Mexico Statewide		1	100	2			2							www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	www.mylovelacemedicarenm.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000000000000001100000000	2		1					1
H3259	001	0	1	01	01	H3259_001_0	8	2	1	08/05/2014	2015.01	08/05/2014 04:05:34 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	VOLUNTEER STATE HEALTH PLAN	BlueCare Plus Tennessee	bluecareplus.bcbst.com	BlueCare Plus (HMO SNP)	01	01		1			H3259	001	0	2015	Tennessee		2	6500	2			1	3		1	4			bluecareplus.bcbst.com	bluecareplus.bcbst.com	bluecareplus.bcbst.com	(800)332-5762		(800)332-5762		(888)413-9637		(888)413-9637		(800)332-5762		(800)332-5762		(888)413-9637		(888)413-9637		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3305	007	0	1	02	01	H3305_007_0	5		1	07/24/2014	2015.01	07/24/2014 09:07:07 PM Eastern Daylight Time	06/09/2014 07:36:46 AM Eastern Daylight Time				07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold without Part D (HMO-POS)	01	02		1			H3305	007	0	2015	Western NY (Rochester/Buffalo)		2	1815	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2
H3305	015	0	1	02	01	H3305_015_0	10		1	07/24/2014	2015.01	07/24/2014 09:10:50 PM Eastern Daylight Time	06/09/2014 07:36:40 AM Eastern Daylight Time	05/31/2014 03:30:40 PM Eastern Daylight Time			07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	GoldValue with Part D (HMO-POS)	01	02		1			H3305	015	0	2015	Western NY (Rochester/Buffalo)		2	14316	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H3305	801	0	1	02	01	H3305_801_0	3		1	05/29/2014	2015.01	05/29/2014 01:19:47 PM Eastern Daylight Time	06/09/2014 07:36:34 AM Eastern Daylight Time				06/09/2014 02:20:20 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold - Employer Group (HMO-POS)	01	02		1			H3305	801	0	2015	Employer Group West Region		1	721	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	011111111111111111111111111111111111	2		1	1	011111111111111111111111111111111111	2		1
H3305	803	0	1	02	01	H3305_803_0	3		1	05/29/2014	2015.01	05/29/2014 11:24:12 AM Eastern Daylight Time	06/09/2014 07:36:26 AM Eastern Daylight Time				06/09/2014 02:20:20 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H3305	803	0	2015	Employer Group West Region		1	6004	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	011111111111111111111111111111111111	2		1	1	011111111111111111111111111111111111	2		1
H3307	002	0	1	01	01	H3307_002_0	2		1	05/30/2014	2015.01	05/30/2014 04:31:29 PM Central Daylight Time	08/04/2014 04:18:07 PM Central Daylight Time	07/31/2014 03:24:30 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3307	002	0	2015	New York City		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3307	012	0	1	01	01	H3307_012_0	2		1	05/30/2014	2015.01	05/30/2014 04:33:29 PM Central Daylight Time	08/04/2014 03:40:32 PM Central Daylight Time	07/31/2014 03:24:35 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3307	012	0	2015	Rockland, Orange and Westchester counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3307	015	0	1	01	01	H3307_015_0	2		1	05/30/2014	2015.01	05/30/2014 04:33:45 PM Central Daylight Time	08/04/2014 04:19:34 PM Central Daylight Time	07/31/2014 03:24:39 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Mosaic (HMO)	01	01		1			H3307	015	0	2015	New York City		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)870-9604		(866)870-9604		(800)547-5514		(800)547-5514		(866)870-9604		(866)870-9604		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3307	018	0	1	01	01	H3307_018_0	1		1	05/29/2014	2015.01	05/29/2014 08:35:43 AM Central Daylight Time	05/30/2014 05:17:36 PM Central Daylight Time				05/31/2014 10:35:20 AM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3307	018	0	2015	NYC and Rockland, Orange, and Westchester Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H3307	023	0	1	01	01	H3307_023_0	2		1	05/30/2014	2015.01	05/30/2014 04:34:11 PM Central Daylight Time	08/04/2014 04:20:26 PM Central Daylight Time	07/31/2014 03:24:44 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3307	023	0	2015	Rockland, Orange, and Westchester counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3307	802	0	1	01	01	H3307_802_0	1		1	05/22/2014	2015.01	05/22/2014 09:10:15 AM Central Daylight Time	05/30/2014 05:18:42 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	802	0	2015	New York Metropolitan Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3307	804	0	1	01	01	H3307_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:10:54 AM Central Daylight Time	05/30/2014 05:19:13 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	804	0	2015	New York Metropolitan Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H3307	805	0	1	01	01	H3307_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:11:02 AM Central Daylight Time	05/30/2014 05:19:45 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	OXFORD HEALTH PLANS (NY), INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3307	805	0	2015	State of New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3312	002	0	1	01	01	H3312_002_0	5		1	08/05/2014	2015.01	08/05/2014 04:32:02 PM Eastern Daylight Time	08/04/2014 09:49:32 PM Eastern Daylight Time	08/01/2014 09:37:49 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3312	002	0	2015	Bronx, Kings and Richmond Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3312	018	0	1	01	01	H3312_018_0	5		1	06/01/2014	2015.01	06/01/2014 02:33:55 AM Eastern Daylight Time	08/04/2014 09:53:00 PM Eastern Daylight Time	08/01/2014 09:37:58 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	018	0	2015	Rockland and Westchester Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3312	048	0	1	01	01	H3312_048_0	4		1	06/01/2014	2015.01	06/01/2014 02:34:28 AM Eastern Daylight Time	08/04/2014 09:54:48 PM Eastern Daylight Time	08/01/2014 09:38:08 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	048	0	2015	Upstate New York		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3312	060	0	1	01	01	H3312_060_0	5		1	06/01/2014	2015.01	06/01/2014 02:34:59 AM Eastern Daylight Time	08/04/2014 10:00:46 PM Eastern Daylight Time	08/01/2014 09:38:18 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	060	0	2015	New York and Queens Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3312	061	0	1	01	01	H3312_061_0	5		1	08/03/2014	2015.01	08/03/2014 11:28:16 AM Eastern Daylight Time	08/04/2014 10:01:56 PM Eastern Daylight Time	08/01/2014 09:38:29 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3312	061	0	2015	Bronx, Kings and Richmond Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3312	801	0	1	01	01	H3312_801_0	2		1	05/23/2014	2015.01	05/23/2014 12:27:41 PM Eastern Daylight Time	07/10/2014 11:49:54 AM Eastern Daylight Time				07/21/2014 11:50:14 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3312	801	0	2015	New York		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H3312	804	0	1	01	01	H3312_804_0	2		1	05/23/2014	2015.01	05/23/2014 12:30:55 PM Eastern Daylight Time	07/10/2014 11:55:29 AM Eastern Daylight Time				07/21/2014 11:50:14 AM Eastern Daylight Time	AETNA HEALTH, INC. (NY)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3312	804	0	2015	New York		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H3321	001	0	1	20	08	H3321_001_0	1		1	05/20/2014	2015.01	05/20/2014 01:14:02 PM Eastern Daylight Time		05/16/2014 12:10:25 PM Eastern Daylight Time			05/20/2014 01:17:53 PM Eastern Daylight Time	INDEPENDENT LIVING SRVCS OF CENTRAL NY	Independent Living Srvcs Of Central Ny	www.loretto-cny.org	Loretto Independent Living Services, Inc (PACE)	08	20		1			H3321	001	0	2015	Onondaga County		2		2			2								Independent Living Services of Central New York, Inc	www.loretto-cny.org									(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800										(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800												
H3321	003	0	1	20	08	H3321_003_0	1		1	05/20/2014	2015.01	05/20/2014 01:14:49 PM Eastern Daylight Time		05/16/2014 12:31:26 PM Eastern Daylight Time			05/20/2014 01:17:53 PM Eastern Daylight Time	INDEPENDENT LIVING SRVCS OF CENTRAL NY	Independent Living Srvcs Of Central Ny	www.loretto-cny.org	Loretto Independent Living Services, Inc (PACE)	08	20		1			H3321	003	0	2015	Onondaga County		2		2			2								Independent Living Services of Central New York, Inc	www.loretto-cny.org									(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800										(877)208-5284		(315)452-5800		(877)208-5284		(315)452-5800												
H3322	001	0	1	20	08	H3322_001_0	1		1	05/19/2014	2015.01	05/19/2014 10:51:53 AM Eastern Daylight Time		05/17/2014 11:45:42 AM Eastern Daylight Time			05/19/2014 10:54:56 AM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	www.nehealth.com/Senior_Services/Senior_Care_PACE/	Senior Care Connection dba Eddy SeniorCare (PACE)	08	20		1			H3322	001	0	2015	Schenectady County, Albany County, NY		2		2			2								www.northeasthealth.com	www.northeasthealth.com									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361											
H3322	002	0	1	20	08	H3322_002_0	1		1	05/19/2014	2015.01	05/19/2014 10:52:19 AM Eastern Daylight Time		05/17/2014 11:54:24 AM Eastern Daylight Time			05/19/2014 10:54:56 AM Eastern Daylight Time	SENIOR CARE CONNECTION, INC.	Eddy SeniorCare	www.nehealth.com/Senior_Services/Senior_Care_PACE/	Senior Care Connection dba:  Eddy SeniorCare (PACE)	08	20		1			H3322	002	0	2015	Schenectady County, Albany County		2		2			2								www.northeasthealth.com	www.northeasthealth.com									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361									(518)382-4567		(518)382-4567		(518)382-3290	6361	(518)382-3290	6361											
H3327	001	0	1	01	01	H3327_001_0	7		1	08/01/2014	2015.02	08/01/2014 01:59:50 PM Eastern Daylight Time	08/01/2014 10:21:08 AM Eastern Daylight Time	07/31/2014 03:11:22 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Power (HMO)	01	01		1			H3327	001	0	2015	New York City and Westchester County		2	5055	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	002	0	1	01	01	H3327_002_0	7		1	08/01/2014	2015.02	08/01/2014 01:57:56 PM Eastern Daylight Time	08/01/2014 09:40:54 AM Eastern Daylight Time	07/31/2014 03:11:54 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Total (HMO)	01	01		1			H3327	002	0	2015	New York City and Westchester County		2	5922	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	026	0	1	01	01	H3327_026_0	7	2	1	07/23/2014	2015.02	07/23/2014 03:44:39 PM Eastern Daylight Time	08/01/2014 09:43:38 AM Eastern Daylight Time	07/31/2014 03:12:40 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Prestige (HMO SNP)	01	01		1			H3327	026	0	2015	Bronx, Queens, Kings, Richmond and Westchester		2	2826	2			1	3		1	5			http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	038	0	1	02	01	H3327_038_0	8		1	08/01/2014	2015.02	08/01/2014 01:58:14 PM Eastern Daylight Time	08/01/2014 10:27:58 AM Eastern Daylight Time	07/31/2014 03:13:10 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Freedom (HMO-POS)	01	02		1			H3327	038	0	2015	New York City and Westchester County		2	114	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	039	0	1	02	01	H3327_039_0	5		1	07/23/2014	2015.02	07/23/2014 03:45:57 PM Eastern Daylight Time	07/16/2014 03:54:44 PM Eastern Daylight Time				07/23/2014 03:59:51 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Clear (HMO-POS)	01	02		1			H3327	039	0	2015	New York City and Westchester County		2	60	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650										(711)-		(711)-		(711)-		(711)-										2					2					2
H3327	040	0	1	01	01	H3327_040_0	5		1	08/01/2014	2015.02	08/01/2014 01:59:27 PM Eastern Daylight Time	08/01/2014 10:39:46 AM Eastern Daylight Time	07/31/2014 03:13:40 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Power (HMO)	01	01		1			H3327	040	0	2015	Orange County		2	177	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	041	0	1	01	01	H3327_041_0	7		1	07/23/2014	2015.02	07/23/2014 03:46:25 PM Eastern Daylight Time	08/01/2014 09:48:44 AM Eastern Daylight Time	07/31/2014 03:14:18 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Total (HMO)	01	01		1			H3327	041	0	2015	Orange County		2	217	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	042	0	1	01	01	H3327_042_0	6	2	1	07/23/2014	2015.02	07/23/2014 03:46:42 PM Eastern Daylight Time	08/01/2014 09:54:22 AM Eastern Daylight Time	07/31/2014 03:14:54 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Prestige (HMO SNP)	01	01		1			H3327	042	0	2015	Orange County		2	62	2			1	3		1	5			http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	043	0	1	01	01	H3327_043_0	8	2	1	07/23/2014	2015.02	07/23/2014 03:46:54 PM Eastern Daylight Time	08/01/2014 10:04:16 AM Eastern Daylight Time	07/31/2014 03:15:26 PM Eastern Daylight Time			08/01/2014 02:13:22 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Grand (HMO SNP)	01	01		1			H3327	043	0	2015	New York City and Hudson Counties		2	159	2			1	3		1	5			http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	801	0	1	01	01	H3327_801_0	6		1	07/11/2014	2015.02	07/11/2014 02:27:09 PM Eastern Daylight Time	07/21/2014 06:50:39 AM Eastern Daylight Time				07/21/2014 03:44:01 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Power (HMO)	01	01		1			H3327	801	0	2015	Employer - New York		1	42	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3327	802	0	1	01	01	H3327_802_0	6		1	07/11/2014	2015.02	07/11/2014 02:27:18 PM Eastern Daylight Time	07/21/2014 06:52:33 AM Eastern Daylight Time				07/21/2014 03:44:01 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Clear (HMO)	01	01		1			H3327	802	0	2015	Employer - New York		1	42	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650										(711)-		(711)-		(711)-		(711)-										2					2					2
H3327	803	0	1	01	01	H3327_803_0	6		1	07/11/2014	2015.02	07/11/2014 02:27:25 PM Eastern Daylight Time	07/21/2014 06:54:12 AM Eastern Daylight Time				07/21/2014 03:44:01 PM Eastern Daylight Time	TOUCHSTONE HEALTH HMO, INC.	Touchstone Health	http://www.touchstoneh.com	Touchstone Health Medicare Power (HMO)	01	01		1			H3327	803	0	2015	Employer - New York		1	42	2			2							http://directory.touchstoneh.com/idirectory	http://www.touchstoneh.com/formulary	http://www.touchstoneh.com/pharmacy	(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(888)777-0204		(888)777-0204		(877)805-3650		(877)805-3650		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3328	001	0	1	02	01	H3328_001_0	7		1	06/19/2014	2015.01	06/19/2014 10:04:59 AM Eastern Daylight Time	07/14/2014 06:46:15 PM Eastern Daylight Time				07/15/2014 08:40:17 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage without Rx (HMO-POS)	01	02		1			H3328	001	0	2015	NY Counties		2	130	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707										(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125										2					2					2
H3328	002	0	1	01	01	H3328_002_0	9	2	1	08/05/2014	2015.01	08/05/2014 02:55:24 PM Eastern Daylight Time	08/04/2014 09:00:09 PM Eastern Daylight Time	08/04/2014 04:59:33 PM Eastern Daylight Time			08/05/2014 04:39:26 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Dual Advantage (HMO SNP)	01	01		1			H3328	002	0	2015	NY Counties		2	2384	2			1	3		1	4			www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	003	0	1	02	01	H3328_003_0	12		1	09/22/2014	2015.01	09/22/2014 04:36:10 PM Eastern Daylight Time	08/04/2014 05:18:43 PM Eastern Daylight Time	07/31/2014 06:42:03 PM Eastern Daylight Time			09/22/2014 04:40:03 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Flex (HMO-POS)	01	02		1			H3328	003	0	2015	NY Counties		2	10873	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	016	0	1	01	01	H3328_016_0	9	2	1	08/05/2014	2015.01	08/05/2014 12:02:41 PM Eastern Daylight Time	08/04/2014 09:03:28 PM Eastern Daylight Time	08/04/2014 04:16:45 PM Eastern Daylight Time			08/05/2014 04:39:26 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicaid Advantage Plus (HMO SNP)	01	01		1			H3328	016	0	2015	NY Counties		2	239	2			1	3		1	4			www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	017	0	1	01	01	H3328_017_0	10	2	1	09/22/2014	2015.01	09/22/2014 04:36:44 PM Eastern Daylight Time	08/04/2014 08:49:34 PM Eastern Daylight Time	08/04/2014 08:48:20 PM Eastern Daylight Time			09/22/2014 04:40:03 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Dual Advantage Flex (HMO SNP)	01	01		1			H3328	017	0	2015	NY Counties		2	8402	2			1	3		1	4			www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	018	0	1	01	01	H3328_018_0	9		1	08/05/2014	2015.01	08/05/2014 09:22:01 AM Eastern Daylight Time	08/04/2014 09:43:13 PM Eastern Daylight Time	08/04/2014 09:39:48 PM Eastern Daylight Time			08/05/2014 04:39:26 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Long Term Care Advantage (HMO SNP)	01	01		1			H3328	018	0	2015	NY Counties		2	16	2			1	1	1	1				www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	019	0	1	01	01	H3328_019_0	9		1	08/05/2014	2015.01	08/05/2014 01:32:15 PM Eastern Daylight Time	08/04/2014 09:07:42 PM Eastern Daylight Time	07/31/2014 06:07:16 PM Eastern Daylight Time			08/05/2014 04:39:26 PM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare $0 Premium (HMO)	01	01		1			H3328	019	0	2015	NY Counties		2	2197	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	801	0	1	02	01	H3328_801_0	4		1	06/01/2014	2015.01	06/01/2014 09:52:11 AM Eastern Daylight Time	05/30/2014 09:03:03 PM Eastern Daylight Time				06/01/2014 10:14:03 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer without RX (HMO-POS)	01	02		1			H3328	801	0	2015	New York Counties		1	500	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707										(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125										2					2					2
H3328	802	0	1	02	01	H3328_802_0	4		1	06/01/2014	2015.01	06/01/2014 09:52:21 AM Eastern Daylight Time	05/30/2014 09:06:53 PM Eastern Daylight Time				06/01/2014 10:14:03 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer (HMO-POS)	01	02		1			H3328	802	0	2015	New York Counties		1	500	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3328	803	0	1	02	01	H3328_803_0	4		1	06/01/2014	2015.01	06/01/2014 09:52:31 AM Eastern Daylight Time	05/30/2014 09:10:06 PM Eastern Daylight Time				06/01/2014 10:14:03 AM Eastern Daylight Time	THE NEW YORK STATE CATHOLIC HEALTH PLAN, INC.	Fidelis Care	www.fideliscare.org	Fidelis Medicare Advantage Employer Non-calendar (HMO-POS)	01	02		1			H3328	803	0	2015	New York Counties		1	500	2			2							www.fideliscare.org	www.fideliscare.org	www.fideliscare.org	(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)247-1447		(800)247-1447		(800)860-8707		(800)860-8707		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		(800)695-8544		(800)695-8544		(800)558-1125		(800)558-1125		2					2					2
H3329	001	0	1	20	08	H3329_001_0	1		1	05/27/2014	2015.01	05/27/2014 06:17:28 PM Eastern Daylight Time		05/26/2014 05:54:43 PM Eastern Daylight Time			05/27/2014 06:30:54 PM Eastern Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare, Inc.	www.centerlighthealthcare.org	CenterLight Healthcare PACE Dual Eligible (PACE)	08	20		1			H3329	001	0	2015	NYC  and Westchester Counties		2		2			2								N/A	N/A									(877)226-8500		(347)640-6280		(877)226-8500		(347)640-6280										(800)650-2774		(800)650-2774		(800)650-2774		(800)650-2774												
H3329	002	0	1	20	08	H3329_002_0	1		1	05/27/2014	2015.01	05/27/2014 06:08:10 PM Eastern Daylight Time		05/26/2014 06:09:03 PM Eastern Daylight Time			05/27/2014 06:30:54 PM Eastern Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare, Inc.	www.centerlighthealthcare.org	CenterLight Healthcare - PACE - Medicare only (PACE)	08	20		1			H3329	002	0	2015	NYC and Westchester Counties		2		2			2								N/A	N/A									(800)935-7195		(800)935-7195		(877)226-8500		(347)640-6280										(800)759-1089		(800)759-1089		(711)-		(711)-												
H3330	021	1	1	01	01	H3330_021_1	8		1	07/24/2014	2015.01	07/24/2014 10:48:47 AM Eastern Daylight Time	08/05/2014 01:23:04 PM Eastern Daylight Time	08/05/2014 01:23:21 PM Eastern Daylight Time			09/18/2014 03:56:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	1	2015	Counties of NYC, Westchester and Long Island	New York City	2	161259	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	021	2	1	01	01	H3330_021_2	9		1	05/30/2014	2015.01	05/30/2014 01:24:49 PM Eastern Daylight Time	08/05/2014 01:23:54 PM Eastern Daylight Time	08/05/2014 01:24:26 PM Eastern Daylight Time			09/18/2014 03:56:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	2	2015	Counties of NYC, Westchester and Long Island	Nassau County	2	71085	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	021	3	1	01	01	H3330_021_3	8		1	05/30/2014	2015.01	05/30/2014 01:26:22 PM Eastern Daylight Time	08/05/2014 01:25:01 PM Eastern Daylight Time	08/05/2014 01:25:10 PM Eastern Daylight Time			09/18/2014 03:56:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP (HMO)	01	01		1			H3330	021	3	2015	Counties of NYC, Westchester and Long Island	Suffolk and Westchester Counties	2	14049	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	029	0	1	01	01	H3330_029_0	9	2	1	08/05/2014	2015.01	08/05/2014 12:58:45 PM Eastern Daylight Time	08/05/2014 01:25:26 PM Eastern Daylight Time	08/05/2014 01:25:37 PM Eastern Daylight Time			09/18/2014 04:04:59 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Dual Eligible (HMO SNP)	01	01		1			H3330	029	0	2015	Counties of NYC, Westchester and Long Island		2	108965	2			1	3		1	2			www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	032	1	1	01	01	H3330_032_1	7		1	08/05/2014	2015.01	08/05/2014 12:57:35 PM Eastern Daylight Time	08/05/2014 01:26:17 PM Eastern Daylight Time	08/05/2014 01:26:30 PM Eastern Daylight Time			09/18/2014 04:04:59 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	1	2015	Counties of NYC, Westchester and Long Island	New York City	2	143986	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	032	2	1	01	01	H3330_032_2	8		1	05/30/2014	2015.01	05/30/2014 01:37:09 PM Eastern Daylight Time	08/05/2014 01:26:51 PM Eastern Daylight Time	08/05/2014 01:27:11 PM Eastern Daylight Time			09/18/2014 04:04:59 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	2	2015	Counties of NYC, Westchester and Long Island	Nassau	2	32846	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	032	3	1	01	01	H3330_032_3	7		1	05/30/2014	2015.01	05/30/2014 01:30:42 PM Eastern Daylight Time	08/05/2014 01:27:33 PM Eastern Daylight Time	08/05/2014 01:27:51 PM Eastern Daylight Time			09/18/2014 04:04:59 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Essential (HMO)	01	01		1			H3330	032	3	2015	Counties of NYC, Westchester and Long Island	Suffolk and Westchester	2	7043	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	033	1	1	01	01	H3330_033_1	8		1	05/30/2014	2015.01	05/30/2014 01:31:48 PM Eastern Daylight Time	08/05/2014 01:28:16 PM Eastern Daylight Time	08/05/2014 01:43:04 PM Eastern Daylight Time			09/18/2014 04:11:55 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	1	2015	Counties of NYC, Westchester and Long Island	New York City	2	21695	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	033	2	1	01	01	H3330_033_2	10		1	05/30/2014	2015.01	05/30/2014 01:32:22 PM Eastern Daylight Time	08/05/2014 01:30:26 PM Eastern Daylight Time	08/05/2014 01:30:46 PM Eastern Daylight Time			09/18/2014 04:11:55 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	2	2015	Counties of NYC, Westchester and Long Island	Nassau	2	15905	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	033	3	1	01	01	H3330_033_3	10		1	05/30/2014	2015.01	05/30/2014 01:32:55 PM Eastern Daylight Time	08/05/2014 01:30:05 PM Eastern Daylight Time	08/05/2014 01:31:14 PM Eastern Daylight Time			09/18/2014 04:11:55 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP High Option (HMO)	01	01		1			H3330	033	3	2015	Counties of NYC, Westchester and Long Island	Suffolk and Westchester	2	5957	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	035	0	1	01	01	H3330_035_0	11	2	1	08/05/2014	2015.01	08/05/2014 12:59:12 PM Eastern Daylight Time	08/05/2014 01:29:10 PM Eastern Daylight Time	08/05/2014 01:28:56 PM Eastern Daylight Time			09/18/2014 04:11:55 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our plans/medicare	EmblemHealth MLTC PLUS (HMO SNP)	01	01		1			H3330	035	0	2015	Counties of NYC, Westchester and Long Island		2	6687	2			1	3		1	2			www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	808	0	2	01	01	H3330_808_0	6		1	05/28/2014	2015.01	05/28/2014 12:26:26 PM Eastern Daylight Time	06/09/2014 03:13:42 PM Eastern Daylight Time				09/18/2014 04:21:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Part A Payers (HMO)	01	01		2	1		H3330	808	0	2015	Counties of NYC:, Westchester and Long Island		1	12	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	810	0	1	01	01	H3330_810_0	8	2	1	05/28/2014	2015.01	05/28/2014 12:26:39 PM Eastern Daylight Time	07/10/2014 05:37:15 PM Eastern Daylight Time				09/18/2014 04:21:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Dual Eligible Group (HMO SNP)	01	01		1			H3330	810	0	2015	Counties of NYC, Westchester and Long Island		1	3423	2			1	3		1	2			www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	814	0	1	01	01	H3330_814_0	6		1	05/28/2014	2015.01	05/28/2014 12:26:58 PM Eastern Daylight Time	06/09/2014 03:14:02 PM Eastern Daylight Time				09/18/2014 04:21:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier (HMO)	01	01		1			H3330	814	0	2015	Counties of NYC, Nassau, Suffolk, Westchester		1	758821	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3330	815	0	1	01	01	H3330_815_0	6		1	05/28/2014	2015.01	05/28/2014 01:11:45 PM Eastern Daylight Time	06/09/2014 03:14:12 PM Eastern Daylight Time				09/18/2014 04:21:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Rx Carveout (HMO)	01	01		1			H3330	815	0	2015	Counties of NYC, Nassau, Suffolk, Westchester		1	780	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					2
H3330	817	0	1	01	01	H3330_817_0	4		1	05/28/2014	2015.01	05/28/2014 12:27:26 PM Eastern Daylight Time	06/09/2014 08:20:06 AM Eastern Daylight Time				09/18/2014 04:21:09 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth Medicare HMO	www.emblemhealth.com/our-plans/medicare	EmblemHealth VIP Premier Plus (HMO)	01	01		1			H3330	817	0	2015	Counties of NYC, Nassau, Suffolk and Westchester		1	169	2			2							www.emblemhealth.com/our-plans/medicare	emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3331	001	0	1	20	08	H3331_001_0	1		1	06/02/2014	2015.01	06/02/2014 01:51:39 PM Eastern Daylight Time		06/02/2014 01:51:11 PM Eastern Daylight Time			06/02/2014 01:54:56 PM Eastern Daylight Time	INDEPENDENT LIVING FOR SENIORS, INC.	ElderONE	www.ElderONE.org	Living for Seniors Dually Eligible (PACE)	08	20		1			H3331	001	0	2015	Monroe County		2		2			2								www.rochestergeneral.org	www.rochestergeneral.org/hillhaven									(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831										(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831												
H3331	002	0	1	20	08	H3331_002_0	1		1	06/02/2014	2015.01	06/02/2014 01:29:24 PM Eastern Daylight Time		06/02/2014 01:51:18 PM Eastern Daylight Time			06/02/2014 01:54:56 PM Eastern Daylight Time	INDEPENDENT LIVING FOR SENIORS, INC.	ElderONE	www.ElderONE.org	Independent Living for Seniors Care only (PACE)	08	20		1			H3331	002	0	2015	Monroe County		2		2			2								www.rochestergeneral.org	www.rochestergeneral.org/hillhaven									(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831										(800)896-0211		(585)922-2831		(800)896-0211		(585)922-2831												
H3335	005	0	1	04	01	H3335_005_0	8		1	07/23/2014	2015.01	07/23/2014 05:11:34 PM Eastern Daylight Time	07/31/2014 05:17:16 PM Eastern Daylight Time	07/31/2014 05:22:40 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure PPO (PPO)	01	04		1			H3335	005	0	2015	Utica-Rome Metro		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	006	0	1	04	01	H3335_006_0	7		1	07/23/2014	2015.01	07/23/2014 05:11:57 PM Eastern Daylight Time	07/31/2014 05:17:38 PM Eastern Daylight Time	07/31/2014 05:22:52 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced PPO (PPO)	01	04		1			H3335	006	0	2015	Utica-Rome Metro		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	014	0	1	04	01	H3335_014_0	7		1	07/23/2014	2015.01	07/23/2014 05:12:18 PM Eastern Daylight Time	07/31/2014 05:18:02 PM Eastern Daylight Time	07/31/2014 05:23:04 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueSecure PPO (PPO)	01	04		1			H3335	014	0	2015	Central New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	015	0	1	04	01	H3335_015_0	7		1	07/23/2014	2015.01	07/23/2014 05:12:35 PM Eastern Daylight Time	07/31/2014 05:18:26 PM Eastern Daylight Time	07/31/2014 05:23:18 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueEnhanced PPO (PPO)	01	04		1			H3335	015	0	2015	Central New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	018	0	1	04	01	H3335_018_0	7		1	07/23/2014	2015.01	07/23/2014 05:12:51 PM Eastern Daylight Time	07/31/2014 05:18:50 PM Eastern Daylight Time	07/31/2014 05:23:30 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BluePlus PPO (PPO)	01	04		1			H3335	018	0	2015	East New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	038	0	1	04	01	H3335_038_0	7		1	07/23/2014	2015.01	07/23/2014 05:13:08 PM Eastern Daylight Time	07/31/2014 05:19:14 PM Eastern Daylight Time	07/31/2014 05:23:44 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic PPO (PPO)	01	04		1			H3335	038	0	2015	Central New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	041	0	1	04	01	H3335_041_0	7		1	07/23/2014	2015.01	07/23/2014 05:13:25 PM Eastern Daylight Time	06/04/2014 03:42:20 PM Eastern Daylight Time				07/23/2014 05:58:53 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic PPO (PPO)	01	04		1			H3335	041	0	2015	Utica-Rome Metro		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					
H3335	043	0	1	04	01	H3335_043_0	6		1	07/23/2014	2015.01	07/23/2014 05:13:48 PM Eastern Daylight Time	06/02/2014 08:18:02 AM Eastern Daylight Time				07/23/2014 05:58:53 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic PPO (PPO)	01	04		1			H3335	043	0	2015	Central New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					
H3335	044	0	1	04	01	H3335_044_0	5		1	07/23/2014	2015.01	07/23/2014 05:14:07 PM Eastern Daylight Time	06/02/2014 08:18:02 AM Eastern Daylight Time				07/23/2014 05:58:53 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueBasic PPO (PPO)	01	04		1			H3335	044	0	2015	East New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					
H3335	051	0	1	04	01	H3335_051_0	7		1	07/23/2014	2015.01	07/23/2014 05:14:22 PM Eastern Daylight Time	07/31/2014 05:19:38 PM Eastern Daylight Time	08/05/2014 04:10:30 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare BlueClassic PPO (PPO)	01	04		1			H3335	051	0	2015	Utica-Rome Metro		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	052	0	1	04	01	H3335_052_0	6		1	07/23/2014	2015.01	07/23/2014 05:14:50 PM Eastern Daylight Time	07/31/2014 05:20:00 PM Eastern Daylight Time	08/05/2014 04:11:08 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Bassett PPO (PPO)	01	04		1			H3335	052	0	2015	East New York		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					
H3335	801	0	1	04	01	H3335_801_0	2		1	05/30/2014	2015.01	05/30/2014 09:58:46 AM Eastern Daylight Time	06/02/2014 08:18:03 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare PPO Group (PPO)	01	04		1			H3335	801	0	2015	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011010011010000011111110011100000100	2		1					
H3335	811	0	1	04	01	H3335_811_0	3		1	06/02/2014	2015.01	06/02/2014 02:25:10 PM Eastern Daylight Time	06/02/2014 01:05:56 PM Eastern Daylight Time				06/02/2014 02:28:44 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	01	04		1			H3335	811	0	2015	Rochester Metro Area and Eastern New York Area		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	2		1					
H3335	813	0	1	04	01	H3335_813_0	2		1	05/30/2014	2015.01	05/30/2014 09:59:39 AM Eastern Daylight Time	06/02/2014 08:18:03 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare PPO Group (PPO)	01	04		1			H3335	813	0	2015	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										1	1	011100011010000011111110011100000100	2		2					
H3335	819	0	1	04	01	H3335_819_0	3		1	06/02/2014	2015.01	06/02/2014 02:25:30 PM Eastern Daylight Time	06/02/2014 01:05:56 PM Eastern Daylight Time				06/02/2014 02:28:44 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group (PPO)	01	04		1			H3335	819	0	2015	Rochester Metro Area and Eastern New York Area		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										1	1	011100010010000011111110011100000100	2		1					
H3335	820	0	1	04	01	H3335_820_0	3		1	06/02/2014	2015.01	06/02/2014 02:25:49 PM Eastern Daylight Time	06/02/2014 01:05:56 PM Eastern Daylight Time				06/02/2014 02:28:44 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue PPO Group Non-Calendar (PPO)	01	04		1			H3335	820	0	2015	Rochester Metro Area and Eastern New York Area		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	2		1					
H3335	822	0	1	04	01	H3335_822_0	2		1	05/30/2014	2015.01	05/30/2014 09:59:09 AM Eastern Daylight Time	06/02/2014 08:18:04 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera Medicare PPO Group Non-Calendar (PPO)	01	04		1			H3335	822	0	2015	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	2		1					
H3337	001	0	1	01	01	H3337_001_0	6		1	07/16/2014	2015.01	07/16/2014 01:43:29 PM Pacific Daylight Time	08/01/2014 03:54:29 PM Pacific Daylight Time	08/01/2014 05:48:56 PM Pacific Daylight Time			08/01/2014 03:58:31 PM Pacific Daylight Time	LIBERTY HEALTH ADVANTAGE, INC.	Liberty Health Advantage	www.lhany.com	Liberty Health Advantage Preferred Choice (HMO)	01	01		1			H3337	001	0	2015	Bronx, Kings, Nassau, New York, Queens, Richmond		2		2			2							www.lhany.com	http://www.lhany.com	http://www.lhany.com	(866)542-4269		(866)542-4269		(855)439-1660		(855)439-1660		(800)546-5677		(800)546-5677		(855)439-1660		(855)439-1660		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)706-4757		(866)706-4757		(800)662-1220		(800)662-1220		2					2					2
H3337	003	0	1	01	01	H3337_003_0	5	2	1	07/16/2014	2015.01	07/16/2014 12:32:40 PM Pacific Daylight Time	08/01/2014 03:55:40 PM Pacific Daylight Time	08/01/2014 06:33:16 PM Pacific Daylight Time			08/01/2014 03:58:31 PM Pacific Daylight Time	LIBERTY HEALTH ADVANTAGE, INC.	Liberty Health Advantage	www.lhany.com	Liberty Health Advantage Dual Power (HMO SNP)	01	01		1			H3337	003	0	2015	Bronx, Kings, Nassau, New York, Queens, Richmond		2		2			1	3		1	3		2	www.lhany.com	http://www.lhany.com	http://www.lhany.com	(866)542-4269		(866)542-4269		(855)439-1660		(855)439-1660		(800)546-5677		(800)546-5677		(855)439-1660		(855)439-1660		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)706-4757		(866)706-4757		(800)662-1220		(800)662-1220		2					2					2
H3342	019	0	1	04	01	H3342_019_0	12		1	07/15/2014	2015.01	07/15/2014 09:08:21 AM Eastern Daylight Time	08/06/2014 02:51:31 AM Eastern Daylight Time	08/01/2014 05:30:54 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom I (PPO)	01	04		1			H3342	019	0	2015	Select Counties in New York		2	27110	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)395-5175		(866)395-5175		(800)797-6308		(800)797-6308		(866)395-5175		(866)395-5175		(800)797-6308		(800)797-6308		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3342	020	0	1	04	01	H3342_020_0	11		1	06/01/2014	2015.01	06/01/2014 02:21:23 PM Eastern Daylight Time	08/06/2014 02:51:36 AM Eastern Daylight Time	08/01/2014 05:30:55 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom II (PPO)	01	04		1			H3342	020	0	2015	Saratoga and Schoharie Counties		2	259	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)395-5175		(866)395-5175		(800)797-6308		(800)797-6308		(866)395-5175		(866)395-5175		(800)797-6308		(800)797-6308		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3342	808	0	1	04	01	H3342_808_0	6		1	05/30/2014	2015.01	05/30/2014 03:09:29 PM Pacific Daylight Time	07/15/2014 03:55:04 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	808	0	2015	New York		1	5220	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H3342	809	0	1	04	01	H3342_809_0	6		1	05/30/2014	2015.01	05/30/2014 03:09:33 PM Pacific Daylight Time	07/15/2014 03:56:22 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	809	0	2015	New York		1	1043	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H3342	810	0	1	04	01	H3342_810_0	6		1	05/30/2014	2015.01	05/30/2014 03:09:36 PM Pacific Daylight Time	07/15/2014 03:55:15 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Freedom (PPO)	01	04		1			H3342	810	0	2015	New York		1	50	2			2							www.empireblue.com/medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(866)222-0444		(866)222-0444		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H3344	005	0	1	04	01	H3344_005_0	6		1	07/18/2014	2015.01	07/18/2014 01:23:57 PM Eastern Daylight Time	08/11/2014 01:37:47 PM Eastern Daylight Time	08/06/2014 11:42:40 AM Eastern Daylight Time			08/12/2014 10:36:54 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare Passport Advantage (PPO)	01	04		1			H3344	005	0	2015	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					
H3344	801	0	1	04	01	H3344_801_0	4		1	05/30/2014	2015.01	05/30/2014 10:35:37 AM Eastern Daylight Time	06/10/2014 03:12:11 PM Eastern Daylight Time				06/10/2014 03:27:46 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	801	0	2015	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					
H3344	803	0	1	04	01	H3344_803_0	2		1	05/30/2014	2015.01	05/30/2014 10:35:45 AM Eastern Daylight Time	06/03/2014 08:24:53 AM Eastern Daylight Time				06/03/2014 08:31:07 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	803	0	2015	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					
H3344	804	0	1	04	01	H3344_804_0	2		1	05/30/2014	2015.01	05/30/2014 10:35:53 AM Eastern Daylight Time	06/03/2014 08:24:53 AM Eastern Daylight Time				06/03/2014 08:31:07 AM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Health	independenthealth.com/medicare	Independent Health Medicare PPO Base (PPO)	01	04		1			H3344	804	0	2015	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independentheatlh.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										2					2					
H3347	002	0	1	01	01	H3347_002_0	8	2	1	08/06/2014	2015.01	08/06/2014 04:44:32 PM Eastern Daylight Time	08/04/2014 04:22:58 PM Eastern Daylight Time	07/31/2014 04:50:20 PM Eastern Daylight Time			08/06/2014 08:36:40 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan For Medicaid Beneficiaries (HMO SNP)	01	01		1			H3347	002	0	2015	NYC, Nassau, Suffolk, Lower Hudson		2	3087	2			1	3		1	2			www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3347	003	0	1	01	01	H3347_003_0	8		1	08/06/2014	2015.01	08/06/2014 10:12:23 AM Eastern Daylight Time	08/04/2014 04:23:58 PM Eastern Daylight Time	07/31/2014 04:50:56 PM Eastern Daylight Time			08/06/2014 11:24:32 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Advantage For Nursing Home Residents (HMO SNP)	01	01		1			H3347	003	0	2015	NYC, Nassau, Suffolk, Lower Hudson and Monroe		2	372	2			1	1	1	1				www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3347	005	0	1	01	01	H3347_005_0	7		1	08/06/2014	2015.01	08/06/2014 11:17:34 AM Eastern Daylight Time	08/06/2014 09:52:16 AM Eastern Daylight Time	07/31/2014 04:51:22 PM Eastern Daylight Time			08/06/2014 11:24:32 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Classic: Zero Premium (HMO)	01	01		1			H3347	005	0	2015	NYC, Nassau, and Westchester		2	4972	2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3347	007	0	1	01	01	H3347_007_0	7	2	1	08/06/2014	2015.01	08/06/2014 10:13:48 AM Eastern Daylight Time	08/05/2014 10:11:58 AM Eastern Daylight Time	07/31/2014 04:51:52 PM Eastern Daylight Time			08/06/2014 11:24:32 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Plus Long Term Care (HMO SNP)	01	01		1			H3347	007	0	2015	NYC, Nassau, Suffolk, Lower Hudson and Monroe		2	919	2			1	3		1	3		2	www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3347	009	0	1	01	01	H3347_009_0	9		1	08/06/2014	2015.01	08/06/2014 10:13:39 AM Eastern Daylight Time	08/04/2014 04:51:20 PM Eastern Daylight Time	07/31/2014 04:52:24 PM Eastern Daylight Time			08/06/2014 11:24:32 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Extra Help (HMO)	01	01		1			H3347	009	0	2015	NYC, Nassau, Suffolk and Lower Hudson		2	4224	2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3347	012	0	1	01	01	H3347_012_0	8		1	08/06/2014	2015.01	08/06/2014 11:18:16 AM Eastern Daylight Time	08/06/2014 09:51:10 AM Eastern Daylight Time	07/31/2014 04:52:54 PM Eastern Daylight Time			08/06/2014 11:24:32 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Diabetes Care (HMO SNP)	01	01		1			H3347	012	0	2015	NYC, Nassau, Suffolk, Lower Hudson and Monroe		2	100	2			1	4		1		00000010000000000000		www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3347	013	0	1	01	01	H3347_013_0	9		1	08/06/2014	2015.01	08/06/2014 11:18:49 AM Eastern Daylight Time	08/06/2014 09:45:58 AM Eastern Daylight Time	07/31/2014 04:53:20 PM Eastern Daylight Time			08/06/2014 11:24:32 AM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan	www.elderplan.org	Elderplan Healthy Balance (HMO)	01	01		1			H3347	013	0	2015	Putnam and Rockland		2	100	2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(800)353-3765		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3351	001	0	1	02	01	H3351_001_0	6		1	07/23/2014	2015.01	07/23/2014 05:07:11 PM Eastern Daylight Time	06/02/2014 08:18:04 AM Eastern Daylight Time				07/23/2014 05:58:53 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Select (HMO-POS)	01	02		1			H3351	001	0	2015	Western New York		2		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2
H3351	002	0	1	02	01	H3351_002_0	8		1	07/23/2014	2015.01	07/23/2014 05:07:23 PM Eastern Daylight Time	07/31/2014 05:20:24 PM Eastern Daylight Time	07/31/2014 05:24:24 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Secure (HMO-POS)	01	02		1			H3351	002	0	2015	Western New York		2		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3351	006	0	1	02	01	H3351_006_0	8		1	07/23/2014	2015.01	07/23/2014 05:07:33 PM Eastern Daylight Time	07/31/2014 05:20:48 PM Eastern Daylight Time	07/31/2014 05:24:38 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Optimum (HMO-POS)	01	02		1			H3351	006	0	2015	Metro Rochester		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3351	007	0	1	02	01	H3351_007_0	5		1	07/23/2014	2015.01	07/23/2014 05:07:46 PM Eastern Daylight Time	06/02/2014 08:18:05 AM Eastern Daylight Time				07/23/2014 05:58:53 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Platinum (HMO-POS)	01	02		1			H3351	007	0	2015	Metro Rochester		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										2					2					2
H3351	010	0	1	01	01	H3351_010_0	8		1	07/23/2014	2015.01	07/23/2014 05:07:57 PM Eastern Daylight Time	07/31/2014 05:21:12 PM Eastern Daylight Time	07/31/2014 05:24:50 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value (HMO)	01	01		1			H3351	010	0	2015	Western New York		2		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3351	011	0	1	01	01	H3351_011_0	7		1	07/23/2014	2015.01	07/23/2014 05:08:10 PM Eastern Daylight Time	07/31/2014 05:21:36 PM Eastern Daylight Time	07/31/2014 05:25:04 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value (HMO)	01	01		1			H3351	011	0	2015	Metro Rochester		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3351	012	0	1	01	01	H3351_012_0	7		1	07/23/2014	2015.01	07/23/2014 05:08:18 PM Eastern Daylight Time	08/05/2014 03:05:04 PM Eastern Daylight Time	07/31/2014 05:25:18 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Value Plus (HMO)	01	01		1			H3351	012	0	2015	Western New York		2		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3351	013	0	1	01	01	H3351_013_0	8		1	07/23/2014	2015.01	07/23/2014 05:08:24 PM Eastern Daylight Time	07/31/2014 05:22:26 PM Eastern Daylight Time	07/31/2014 05:25:30 PM Eastern Daylight Time			08/05/2014 05:12:03 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Value Plus (HMO)	01	01		1			H3351	013	0	2015	Metro Rochester		2		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H3351	801	0	1	02	01	H3351_801_0	2		1	05/23/2014	2015.01	05/23/2014 02:28:11 PM Eastern Daylight Time	06/02/2014 08:18:07 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice - Group (HMO-POS)	01	02		1			H3351	801	0	2015	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	1	000000101011000000000000000	1	1	011100011010000011111110011100000100	1	000000101011000000000000000	2
H3351	802	0	1	02	01	H3351_802_0	2		1	05/23/2014	2015.01	05/23/2014 02:28:19 PM Eastern Daylight Time	06/02/2014 08:18:07 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice - Group (HMO-POS)	01	02		1			H3351	802	0	2015	Metro Rochester		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	1	000000101011000000000000000	1	1	011100011010000011111110011100000100	1	000000101011000000000000000	2
H3351	803	0	1	02	01	H3351_803_0	3		1	06/06/2014	2015.01	06/06/2014 02:04:31 PM Eastern Daylight Time	06/04/2014 03:44:32 PM Eastern Daylight Time				06/06/2014 02:14:20 PM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice - Group (HMO-POS)	01	02		1			H3351	803	0	2015	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										1	1	011100011010000011111110011100000100	1	000000101011000000000000000	1	1	011100110010000011111110011100000100	1	000000101011000000000000000	2
H3351	804	0	1	02	01	H3351_804_0	2		1	05/23/2014	2015.01	05/23/2014 02:28:32 PM Eastern Daylight Time	06/02/2014 08:18:07 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice - Group (HMO-POS)	01	02		1			H3351	804	0	2015	Metro Rochester		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220										1	1	011100011010000011111110011100000100	1	000000101011000000000000000	1	1	011100011010000011111110011100000100	1	000000101011000000000000000	2
H3351	805	0	1	02	01	H3351_805_0	2		1	05/23/2014	2015.01	05/23/2014 02:28:39 PM Eastern Daylight Time	06/02/2014 08:18:07 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.UniveraMedicare.com	Univera SeniorChoice Group Non-Calendar (HMO-POS)	01	02		1			H3351	805	0	2015	Western New York		1		2			2							www.UniveraMedicare.com	www.UniveraMedicare.com	www.UniveraMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	1	000000101011000000000000000	1	1	011100011010000011111110011100000100	1	000000101011000000000000000	2
H3351	806	0	1	02	01	H3351_806_0	2		1	05/23/2014	2015.01	05/23/2014 02:28:45 PM Eastern Daylight Time	06/02/2014 08:18:08 AM Eastern Daylight Time				06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.ExcellusMedicare.com	Medicare Blue Choice Group Non-Calendar (HMO-POS)	01	02		1			H3351	806	0	2015	Metro Rochester		1		2			2							www.ExcellusMedicare.com	www.ExcellusMedicare.com	www.ExcellusMedicare.com	(877)883-9577		(877)883-9577		(800)659-1986		(800)659-1986		(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		1	1	011100011010000011111110011100000100	1	000000101011000000000000000	1	1	011100011010000011111110011100000100	1	000000101011000000000000000	2
H3359	001	0	1	01	01	H3359_001_0	8		1	08/05/2014	2015.01	08/05/2014 10:22:28 AM Eastern Daylight Time	08/05/2014 06:16:01 PM Eastern Daylight Time	08/05/2014 06:19:59 PM Eastern Daylight Time			08/06/2014 08:14:57 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst 65 Plus Plan (HMO)	01	01		1			H3359	001	0	2015	New York City and Nassau County		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2
H3359	019	0	1	01	01	H3359_019_0	8		1	07/22/2014	2015.01	07/22/2014 12:10:06 PM Eastern Daylight Time	08/05/2014 06:18:17 PM Eastern Daylight Time	08/05/2014 06:18:52 PM Eastern Daylight Time			08/06/2014 08:14:57 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Increased Benefits Plan (HMO)	01	01		1			H3359	019	0	2015	New York City and Nassau County		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2
H3359	021	0	1	01	01	H3359_021_0	7	2	1	07/22/2014	2015.01	07/22/2014 12:09:42 PM Eastern Daylight Time	08/05/2014 06:17:54 PM Eastern Daylight Time	08/05/2014 06:19:41 PM Eastern Daylight Time			08/06/2014 08:14:57 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Life Improvement Plan (HMO SNP)	01	01		1			H3359	021	0	2015	New York City, Nassau and Westchester Counties		2		2			1	3		1	2			www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2
H3359	027	0	1	01	01	H3359_027_0	7		1	07/22/2014	2015.01	07/22/2014 12:09:17 PM Eastern Daylight Time	06/27/2014 09:05:47 AM Eastern Daylight Time				07/23/2014 02:51:34 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Coordinated Benefits Plan (HMO)	01	01		1			H3359	027	0	2015	New York City and Nassau County		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303										(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821										2					2					2
H3359	034	0	1	01	01	H3359_034_0	8	2	1	07/22/2014	2015.01	07/22/2014 04:33:35 PM Eastern Daylight Time	08/05/2014 06:17:32 PM Eastern Daylight Time	08/05/2014 06:19:23 PM Eastern Daylight Time			08/06/2014 08:14:57 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst CompleteCare (HMO SNP)	01	01		1			H3359	034	0	2015	New York City, Nassau, and Westchester Counties		2		2			1	3		1	5			www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2
H3359	035	0	1	01	01	H3359_035_0	8		1	07/22/2014	2015.01	07/22/2014 12:06:11 PM Eastern Daylight Time	08/05/2014 06:17:05 PM Eastern Daylight Time	08/05/2014 06:18:33 PM Eastern Daylight Time			08/06/2014 08:14:57 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst AssuredCare (HMO SNP)	01	01		1			H3359	035	0	2015	New York City and Nassau County		2		2			1	1	1	1				www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2
H3359	036	0	1	01	01	H3359_036_0	8		1	07/22/2014	2015.01	07/22/2014 12:06:28 PM Eastern Daylight Time	08/05/2014 06:16:28 PM Eastern Daylight Time	08/05/2014 06:19:08 PM Eastern Daylight Time			08/06/2014 08:14:57 AM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst Mount Sinai Select (HMO)	01	01		1			H3359	036	0	2015	Manhattan		2		2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)260-1010		(888)260-1010		(877)237-1303		(877)237-1303		(888)542-3821		(888)542-3821		(888)542-3821		(888)542-3821		(866)236-1069		(866)236-1069		(888)542-3821		(888)542-3821		2					2					2
H3361	043	0	1	01	01	H3361_043_0	7	2	1	05/29/2014	2015.02	05/29/2014 09:19:15 PM Eastern Daylight Time	08/05/2014 11:27:20 AM Eastern Daylight Time	08/01/2014 11:31:33 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Liberty (HMO SNP)	01	01		1			H3361	043	0	2015	Buffalo, Syracuse, Utica, Binghamton, Albany		2	5844	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)491-5746		(866)491-5746		(877)817-5794		(877)817-5794		(866)491-5746		(866)491-5746		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	059	0	1	01	01	H3361_059_0	7		1	05/27/2014	2015.02	05/27/2014 01:40:46 PM Eastern Daylight Time	05/31/2014 02:13:25 PM Eastern Daylight Time				06/02/2014 04:04:36 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Advance (HMO)	01	01		1			H3361	059	0	2015	Albany,Binghamton,Poughkeepsie, Buffalo, Rochester		2	527	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794										(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272										2					2					2
H3361	065	0	1	01	01	H3361_065_0	7	2	1	05/29/2014	2015.02	05/29/2014 09:24:37 PM Eastern Daylight Time	08/05/2014 11:27:35 AM Eastern Daylight Time	08/01/2014 11:31:43 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H3361	065	0	2015	Albany, Binghamton, Poughkeepsie, Buffalo		2	2797	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)482-3363		(866)482-3363		(877)817-5794		(877)817-5794		(866)482-3363		(866)482-3363		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	099	0	1	01	01	H3361_099_0	7		1	08/04/2014	2015.02	08/04/2014 01:28:58 PM Eastern Daylight Time	08/05/2014 11:27:49 AM Eastern Daylight Time	08/01/2014 11:31:53 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Value (HMO)	01	01		1			H3361	099	0	2015	Buffalo, Rochester, Albany, Binghamton		2	22655	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	106	0	1	02	01	H3361_106_0	8		1	08/04/2014	2015.02	08/04/2014 01:29:37 PM Eastern Daylight Time	08/05/2014 11:28:03 AM Eastern Daylight Time	08/01/2014 11:32:03 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Choice (HMO-POS)	01	02		1			H3361	106	0	2015	New York		2	9803	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	109	0	1	01	01	H3361_109_0	8	2	1	08/04/2014	2015.02	08/04/2014 01:30:12 PM Eastern Daylight Time	08/05/2014 11:28:18 AM Eastern Daylight Time	08/01/2014 11:32:13 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H3361	109	0	2015	New York, Nassau-Suffolk		2	16064	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(866)482-3363		(866)482-3363		(877)817-5794		(877)817-5794		(866)482-3363		(866)482-3363		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	130	0	1	01	01	H3361_130_0	7		1	07/24/2014	2015.02	07/24/2014 07:39:56 AM Eastern Daylight Time	08/05/2014 11:28:31 AM Eastern Daylight Time	08/01/2014 11:32:23 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Rx (HMO)	01	01		1			H3361	130	0	2015	New York		2	5914	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	132	0	1	01	01	H3361_132_0	7		1	08/04/2014	2015.02	08/04/2014 01:31:06 PM Eastern Daylight Time	08/05/2014 11:28:44 AM Eastern Daylight Time	08/01/2014 11:32:33 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Choice (HMO)	01	01		1			H3361	132	0	2015	Nassau, Suffolk Counties		2	1104	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3361	133	0	1	01	01	H3361_133_0	7		1	08/04/2014	2015.02	08/04/2014 01:32:37 PM Eastern Daylight Time	08/05/2014 11:28:58 AM Eastern Daylight Time	08/01/2014 11:32:44 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	WELLCARE OF NEW YORK, INC.	WellCare	www.wellcare.com	WellCare Choice (HMO)	01	01		1			H3361	133	0	2015	Ulster County		2	1271	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(800)278-5155		(800)278-5155		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H3362	016	0	1	01	01	H3362_016_0	5		1	07/11/2014	2015.01	07/11/2014 02:35:07 PM Eastern Daylight Time	06/10/2014 03:12:10 PM Eastern Daylight Time				07/22/2014 08:18:19 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 (HMO)	01	01		1			H3362	016	0	2015	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										2					2					2
H3362	017	0	1	02	01	H3362_017_0	6		1	08/12/2014	2015.01	08/12/2014 10:22:42 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time			08/12/2014 10:36:54 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Encompass 65 Basic (HMO-POS)	01	02		1			H3362	017	0	2015	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2
H3362	020	0	1	01	01	H3362_020_0	6		1	08/04/2014	2015.01	08/04/2014 10:12:45 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time			08/06/2014 12:53:43 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Family Choice (HMO SNP)	01	01		1			H3362	020	0	2015	Western New York		2		2			1	1	3	1				www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2
H3362	025	0	1	01	01	H3362_025_0	5	2	1	08/05/2014	2015.01	08/05/2014 02:13:35 PM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time			08/06/2014 12:53:43 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Dual Difference (HMO SNP)	01	01		1			H3362	025	0	2015	Erie and Niagara County		2		2			1	3		1	2			www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					1					1
H3362	026	0	1	02	01	H3362_026_0	6		1	08/04/2014	2015.01	08/04/2014 10:32:41 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time	08/06/2014 11:42:41 AM Eastern Daylight Time			08/06/2014 12:53:43 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Essential (HMO-POS)	01	02		1			H3362	026	0	2015	Western New York		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2
H3362	027	0	1	01	01	H3362_027_0	7		1	08/04/2014	2015.01	08/04/2014 10:40:55 AM Eastern Daylight Time	08/06/2014 11:42:42 AM Eastern Daylight Time	08/06/2014 11:42:42 AM Eastern Daylight Time			08/06/2014 12:53:43 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Network Advantage (HMO)	01	01		1			H3362	027	0	2015	Erie and Niagara		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2
H3362	029	0	1	02	01	H3362_029_0	7		1	08/04/2014	2015.01	08/04/2014 10:38:36 AM Eastern Daylight Time	08/07/2014 11:04:06 AM Eastern Daylight Time	08/06/2014 11:42:40 AM Eastern Daylight Time			08/07/2014 11:21:35 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health's Encompass 65 Select (HMO-POS)	01	02		1			H3362	029	0	2015	Counties: Alleg, Catt, Chaut, Gene, Orleans, WY		2		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					2
H3362	801	0	1	01	01	H3362_801_0	4		1	05/30/2014	2015.01	05/30/2014 10:34:40 AM Eastern Daylight Time	06/10/2014 03:12:11 PM Eastern Daylight Time				06/10/2014 03:27:46 PM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	01	01		1			H3362	801	0	2015	New York State		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					1
H3362	807	0	1	02	01	H3362_807_0	6		1	07/08/2014	2015.01	07/08/2014 12:17:09 PM Eastern Daylight Time	06/10/2014 03:12:11 PM Eastern Daylight Time				07/22/2014 08:18:19 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass POS (HMO-POS)	01	02		1			H3362	807	0	2015	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					1
H3362	817	0	1	02	01	H3362_817_0	4		1	07/08/2014	2015.01	07/08/2014 12:17:27 PM Eastern Daylight Time	06/03/2014 08:24:56 AM Eastern Daylight Time				07/22/2014 08:18:19 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass POS (HMO-POS)	01	02		1			H3362	817	0	2015	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840		2					2					1
H3362	819	0	1	02	01	H3362_819_0	6		1	07/08/2014	2015.01	07/08/2014 12:17:38 PM Eastern Daylight Time	06/10/2014 03:12:11 PM Eastern Daylight Time				07/22/2014 08:18:19 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass POS (HMO-POS)	01	02		1			H3362	819	0	2015	IH Network and Medicare Deemed Network		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										2					2					2
H3362	820	0	1	01	01	H3362_820_0	3		1	05/30/2014	2015.01	05/30/2014 10:35:24 AM Eastern Daylight Time	06/04/2014 09:05:24 AM Eastern Daylight Time				06/04/2014 09:09:00 AM Eastern Daylight Time	INDEPENDENT HEALTH ASSOCIATION, INC.	Independent Health	independenthealth.com/medicare	Independent Health Medicare Encompass (HMO)	01	01		1			H3362	820	0	2015	New York State		1		2			2							www.independenthealth.com	www.independenthealth.com	www.independenthealth.com	(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840										2					2					2
H3370	028	0	1	01	01	H3370_028_0	8	2	1	08/06/2014	2015.01	08/06/2014 11:55:52 AM Eastern Daylight Time	08/06/2014 02:48:58 PM Eastern Daylight Time	08/06/2014 04:05:05 PM Eastern Daylight Time			08/06/2014 04:32:52 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire Dual Advantage (HMO SNP)	01	01		1			H3370	028	0	2015	New York City Area		2	759	2			1	3		1	5			www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	029	1	1	01	01	H3370_029_1	11		1	08/04/2014	2015.01	08/04/2014 10:35:37 AM Eastern Daylight Time	08/06/2014 02:51:40 AM Eastern Daylight Time	08/01/2014 05:30:56 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	1	2015	New York City Area in New York	Bronx Plan	2	4773	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	029	2	1	01	01	H3370_029_2	11		1	08/04/2014	2015.01	08/04/2014 10:35:21 AM Eastern Daylight Time	08/06/2014 02:51:44 AM Eastern Daylight Time	08/01/2014 05:30:57 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	2	2015	New York City Area in New York	Queens	2	13244	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	029	3	1	01	01	H3370_029_3	11		1	08/04/2014	2015.01	08/04/2014 10:16:04 AM Eastern Daylight Time	08/06/2014 02:51:49 AM Eastern Daylight Time	08/01/2014 05:30:58 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	3	2015	New York City Area in New York	Kings and Richmond	2	8395	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	029	4	1	01	01	H3370_029_4	11		1	06/19/2014	2015.01	06/19/2014 10:11:42 AM Pacific Daylight Time	08/06/2014 02:51:53 AM Eastern Daylight Time	08/01/2014 05:30:59 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	029	4	2015	New York City Area in New York	New York	2	4157	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	030	0	1	01	01	H3370_030_0	11		1	07/02/2014	2015.01	07/02/2014 02:31:35 PM Eastern Daylight Time	08/06/2014 02:51:58 AM Eastern Daylight Time	08/01/2014 05:31:00 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Select (HMO)	01	01		1			H3370	030	0	2015	Metro-North and Mid-Hudson Area in New York		2	9472	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	031	0	1	01	01	H3370_031_0	12		1	06/02/2014	2015.01	06/02/2014 06:42:12 PM Eastern Daylight Time	08/06/2014 02:52:02 AM Eastern Daylight Time	08/01/2014 05:31:01 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	031	0	2015	Nassau County in New York		2	5761	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	032	0	1	01	01	H3370_032_0	11		1	06/01/2014	2015.01	06/01/2014 02:20:44 PM Eastern Daylight Time	08/06/2014 02:52:06 AM Eastern Daylight Time	08/01/2014 05:31:02 PM Eastern Daylight Time			08/07/2014 10:15:55 AM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Plus (HMO)	01	01		1			H3370	032	0	2015	Suffolk County in New York		2	8107	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3370	033	0	1	01	01	H3370_033_0	8		1	06/02/2014	2015.01	06/02/2014 06:42:32 PM Eastern Daylight Time	07/15/2014 03:34:45 PM Eastern Daylight Time				07/15/2014 08:47:59 PM Eastern Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue Essential (HMO)	01	01		1			H3370	033	0	2015	Select Counties in New York		2	489	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)499-9554		(800)499-9554		(800)797-6159		(800)797-6159										(711)-		(711)-		(711)-		(711)-										2					2					2
H3370	801	0	1	01	01	H3370_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:35:22 AM Pacific Daylight Time	07/15/2014 01:21:34 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue (HMO)	01	01		1			H3370	801	0	2015	New York State		1	997	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551		(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H3370	803	0	1	01	01	H3370_803_0	8		1	05/31/2014	2015.01	05/31/2014 11:35:35 AM Pacific Daylight Time	07/15/2014 01:21:38 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue (HMO)	01	01		1			H3370	803	0	2015	New York State		1	100	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H3370	805	0	1	01	01	H3370_805_0	8		1	05/31/2014	2015.01	05/31/2014 11:36:06 AM Pacific Daylight Time	07/15/2014 01:21:43 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	EMPIRE HEALTHCHOICE HMO, INC.	Empire BlueCross BlueShield	www.empireblue.com/medicare	Empire MediBlue (HMO)	01	01		1			H3370	805	0	2015	New York State		1	50	2			2							www.empireblue.com/Medicare	www.empireblue.com/medicare	www.empireblue.com/medicare	(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551		(800)564-9053		(800)564-9053		(866)205-6551		(866)205-6551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H3379	001	0	1	01	01	H3379_001_0	3		1	05/30/2014	2015.01	05/30/2014 04:34:27 PM Central Daylight Time	08/04/2014 02:45:21 PM Central Daylight Time	07/31/2014 03:24:48 PM Central Daylight Time			08/06/2014 07:09:10 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3379	001	0	2015	New York City		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3379	002	0	1	01	01	H3379_002_0	6		1	07/18/2014	2015.02	07/18/2014 09:27:54 AM Central Daylight Time	08/12/2014 09:40:38 AM Central Daylight Time	07/31/2014 03:24:54 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3379	002	0	2015	New York Metropolitan area		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3379	022	0	1	01	01	H3379_022_0	7		1	07/18/2014	2015.02	07/18/2014 09:28:18 AM Central Daylight Time	08/12/2014 09:42:00 AM Central Daylight Time	07/31/2014 03:25:00 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3379	022	0	2015	Upstate New York		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3384	013	0	1	01	01	H3384_013_0	7		1	07/17/2014	2015.02	07/17/2014 03:40:14 PM Eastern Daylight Time	08/04/2014 11:10:36 PM Eastern Daylight Time	08/04/2014 10:56:06 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	BlueShield Senior Blue HMO 652 PartD (HMO)	01	01		1			H3384	013	0	2015	Northeastern New York		2	1109	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3384	019	0	1	01	01	H3384_019_0	7		1	08/05/2014	2015.02	08/05/2014 04:07:56 PM Eastern Daylight Time	08/04/2014 11:09:52 PM Eastern Daylight Time	08/04/2014 10:55:12 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue HMO 651 PartD (HMO)	01	01		1			H3384	019	0	2015	Western New York		2	356	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3384	022	0	1	01	01	H3384_022_0	7		1	07/17/2014	2015.02	07/17/2014 03:40:27 PM Eastern Daylight Time	07/15/2014 07:43:34 PM Eastern Daylight Time				07/17/2014 03:46:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue HMO 601 (HMO)	01	01		1			H3384	022	0	2015	Western New York		2	1799	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296										(711)-		(711)-		(711)-		(711)-										2					2					2
H3384	057	0	1	02	01	H3384_057_0	7		1	07/17/2014	2015.02	07/17/2014 03:40:34 PM Eastern Daylight Time	08/04/2014 11:09:14 PM Eastern Daylight Time	08/04/2014 10:54:10 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.healthnowny.com/medicare	HealthNow SelectSaver HMO (HMO-POS)	01	02		1			H3384	057	0	2015	Central New York		2	8	2			2							www.healthnowny.com/medicare	www.healthnowny.com/medicare	www.healthnowny.com/medicare	(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905		(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3384	058	0	1	01	01	H3384_058_0	8		1	07/17/2014	2015.02	07/17/2014 03:40:41 PM Eastern Daylight Time	08/06/2014 06:30:52 AM Eastern Daylight Time	08/08/2014 03:43:22 PM Eastern Daylight Time			08/11/2014 03:09:35 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Senior Blue HMO Select (HMO)	01	01		1			H3384	058	0	2015	Western New York		2	6118	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3384	059	0	1	02	01	H3384_059_0	7		1	07/17/2014	2015.02	07/17/2014 03:40:47 PM Eastern Daylight Time	08/04/2014 11:07:32 PM Eastern Daylight Time	08/04/2014 10:52:28 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	BlueShield Senior Blue 650 Part D (HMO-POS)	01	02		1			H3384	059	0	2015	Northeastern New York		2	313	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3384	805	0	1	01	01	H3384_805_0	4		1	07/17/2014	2015.02	07/17/2014 03:40:54 PM Eastern Daylight Time	07/16/2014 05:05:45 PM Eastern Daylight Time				07/17/2014 03:46:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com	HMO Group MA Only Plan (HMO)	01	01		1			H3384	805	0	2015	Western and Northeastern New York		1	109	2			2							www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296										(711)-		(711)-		(711)-		(711)-										2					2					2
H3384	806	0	1	01	01	H3384_806_0	4		1	07/17/2014	2015.02	07/17/2014 10:32:16 AM Eastern Daylight Time	07/16/2014 05:05:45 PM Eastern Daylight Time				07/17/2014 03:46:28 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com	HMO Group (MA-PD) Calendar Year (HMO)	01	01		1			H3384	806	0	2015	Western and Northeastern New York		1	3334	2			2							www.bcbswny.com	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3387	010	0	1	01	01	H3387_010_0	2	2	1	08/05/2014	2015.02	08/05/2014 10:26:47 AM Central Daylight Time	08/04/2014 04:17:41 PM Central Daylight Time	07/31/2014 03:25:03 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW YORK, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3387	010	0	2015	Select counties in New York		2		2			1	3		1	5			www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)514-4912		(800)514-4912		(888)834-3721		(888)834-3721		(800)514-4912		(800)514-4912		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3388	001	0	1	01	01	H3388_001_0	6		1	07/17/2014	2015.01	07/17/2014 03:28:31 PM Eastern Daylight Time	05/30/2014 02:11:04 PM Eastern Daylight Time				07/17/2014 04:02:19 PM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Choice (HMO)	01	01		1			H3388	001	0	2015	Capital Region of New York State		2	1352	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										2					2					2
H3388	002	0	1	01	01	H3388_002_0	9		1	07/17/2014	2015.01	07/17/2014 03:27:14 PM Eastern Daylight Time	08/05/2014 11:02:17 AM Eastern Daylight Time	08/05/2014 11:02:17 AM Eastern Daylight Time			08/05/2014 11:22:16 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Choice Rx (HMO)	01	01		1			H3388	002	0	2015	Capital Region of New York State		2	19594	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					2
H3388	004	0	1	01	01	H3388_004_0	7		1	07/17/2014	2015.01	07/17/2014 03:27:40 PM Eastern Daylight Time	08/05/2014 11:02:18 AM Eastern Daylight Time	08/05/2014 11:02:18 AM Eastern Daylight Time			08/05/2014 11:22:16 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Value Rx (HMO)	01	01		1			H3388	004	0	2015	Capital Region of New York State		2	7390	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					2
H3388	013	0	1	01	01	H3388_013_0	8		1	07/17/2014	2015.01	07/17/2014 03:28:03 PM Eastern Daylight Time	08/05/2014 11:02:18 AM Eastern Daylight Time	08/05/2014 11:02:18 AM Eastern Daylight Time			08/05/2014 11:22:16 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Basic RX (HMO)	01	01		1			H3388	013	0	2015	Capital Region of New York State		2	1000	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					2
H3388	801	0	1	01	01	H3388_801_0	3		1	05/20/2014	2015.01	05/20/2014 06:06:11 PM Eastern Daylight Time	05/30/2014 02:19:16 PM Eastern Daylight Time				05/31/2014 09:12:01 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	801	0	2015	Upstate New York Region		1	223	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(866)289-2319		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	011111111010101111111110011100000100	1	011111111111111111110000100	1					1
H3388	803	0	1	01	01	H3388_803_0	3		1	05/20/2014	2015.01	05/20/2014 06:06:19 PM Eastern Daylight Time	05/30/2014 02:21:38 PM Eastern Daylight Time				05/31/2014 09:12:01 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (HMO)	01	01		1			H3388	803	0	2015	Upstate New York Region		1	8273	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(866)289-2319		(866)289-2319		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	011111111010101111111110011100000100	1	011111111111111111110000100	1					1
H3388	804	0	1	01	01	H3388_804_0	3		1	05/20/2014	2015.01	05/20/2014 06:06:26 PM Eastern Daylight Time	05/30/2014 02:23:54 PM Eastern Daylight Time				05/31/2014 09:12:01 AM Eastern Daylight Time	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare (HMO)	01	01		1			H3388	804	0	2015	Upstate New York Region		1	380	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										1	1	011111111010101111111110011100000100	1	011111111111111111110000100	1					1
H3404	001	0	1	04	01	H3404_001_0	10		1	08/14/2014	2015.01	08/14/2014 03:51:31 PM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time			08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO Enhanced (PPO)	01	04		1			H3404	001	0	2015	Select North Carolina Counties		2	22786	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					
H3404	002	0	1	04	01	H3404_002_0	9		1	08/14/2014	2015.01	08/14/2014 03:51:45 PM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time			08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO Enhanced Freedom (PPO)	01	04		1			H3404	002	0	2015	Select North Carolina Counties		2	6137	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					
H3404	801	0	1	04	01	H3404_801_0	5		1	08/12/2014	2015.01	08/12/2014 07:26:19 PM Eastern Daylight Time	07/30/2014 11:19:52 AM Eastern Daylight Time				08/12/2014 07:39:18 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO EGWP Medical Only (PPO)	01	04		1			H3404	801	0	2015	North Carolina Employer Groups		1	0	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										1	1	011100011000100101110111001100000000	2		1					
H3404	803	0	1	04	01	H3404_803_0	5		1	08/12/2014	2015.01	08/12/2014 05:57:02 PM Eastern Daylight Time	07/30/2014 11:19:52 AM Eastern Daylight Time				08/12/2014 07:39:18 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare PPO EGWP (PPO)	01	04		1			H3404	803	0	2015	North Carolina Employer Groups		1	75	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(877)494-7647		(877)494-7647		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	1	011100011000100101110111001100000000	2		1					
H3421	001	0	1	09	04	H3421_001_0	5		1	07/18/2014	2015.01	07/18/2014 01:15:01 PM Eastern Daylight Time	06/01/2014 04:12:56 PM Eastern Daylight Time				07/18/2014 02:43:39 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE HEALTH PLANS, INC.	America's 1st Choice Health Plans, Inc.	www.Americas1stChoice.com	Patriot (PFFS)	04	09	1	1			H3421	001	0	2015	Select Counties in SC		2	1	2			2								www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947										(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583										2					2					2
H3421	002	0	1	09	04	H3421_002_0	9		1	07/18/2014	2015.01	07/18/2014 01:16:48 PM Eastern Daylight Time	08/04/2014 03:20:10 PM Eastern Daylight Time	08/04/2014 12:51:26 PM Eastern Daylight Time			08/05/2014 10:52:24 AM Eastern Daylight Time	AMERICA'S 1ST CHOICE HEALTH PLANS, INC.	America's 1st Choice Health Plans, Inc.	www.Americas1stChoice.com	Patriot Plus (PFFS)	04	09	1	1			H3421	002	0	2015	Select Counties in SC		2	1	2			2								www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		2					2					2
H3430	001	0	1	20	08	H3430_001_0	1		1	05/29/2014	2015.01	05/29/2014 10:24:41 AM Eastern Daylight Time		05/28/2014 11:12:30 AM Eastern Daylight Time			05/29/2014 11:37:42 AM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	http://www.suncoastpace.org/	Suncoast Neighborly Care, Inc (PACE)	08	20		1			H3430	001	0	2015	Suncoast Neighborly Care, Inc		2		2			2								http://www.suncoastpace.org/	http://www.suncoastpace.org/									(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062												
H3430	002	0	1	20	08	H3430_002_0	1		1	05/29/2014	2015.01	05/29/2014 10:25:05 AM Eastern Daylight Time		05/28/2014 11:19:26 AM Eastern Daylight Time			05/29/2014 11:37:42 AM Eastern Daylight Time	SUNCOAST PACE, INC.	Suncoast PACE, Inc.	www.neighborly.org	Suncoast Neighborly Care, Inc (PACE)	08	20		1			H3430	002	0	2015	Suncoast Neighborly Care, Inc		2		2			2								http://www.suncoastpace.org/	http://www.suncoastpace.org/									(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062										(866)458-2933		(727)289-0062		(866)458-2933		(727)289-0062												
H3447	001	0	1	01	01	H3447_001_0	8		1	08/04/2014	2015.01	08/04/2014 02:03:59 PM Pacific Daylight Time	08/04/2014 11:46:22 AM Pacific Daylight Time	08/01/2014 02:45:04 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Local (HMO)	01	01		1			H3447	001	0	2015	Richmond Metropolitan and South of Richmond Area		2	1384	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3447	003	0	1	01	01	H3447_003_0	8		1	07/23/2014	2015.01	07/23/2014 06:24:35 PM Pacific Daylight Time	08/04/2014 11:47:07 AM Pacific Daylight Time	08/01/2014 02:45:16 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue COPD (HMO SNP)	01	01		1			H3447	003	0	2015	Richmond Metropolitan and South of Richmond Area		2	115	2			1	4		1		00000000000100000000			www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3447	004	0	1	01	01	H3447_004_0	8		1	07/23/2014	2015.01	07/23/2014 06:25:25 PM Pacific Daylight Time	08/04/2014 11:46:52 AM Pacific Daylight Time	08/01/2014 02:45:29 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Diabetes (HMO SNP)	01	01		1			H3447	004	0	2015	Richmond Metropolitan and South of Richmond Area		2	524	2			1	4		1		00000010000000000000			www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3447	005	0	1	01	01	H3447_005_0	8		1	07/23/2014	2015.01	07/23/2014 06:26:02 PM Pacific Daylight Time	08/04/2014 11:46:36 AM Pacific Daylight Time	08/01/2014 02:45:40 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	HEALTHKEEPERS, INC.	Anthem HealthKeepers	www.anthem.com/medicare	Anthem MediBlue Smart Fit (HMO)	01	01		1			H3447	005	0	2015	Richmond Metropolitan and South of Richmond Area		2	124	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(888)326-3584		(888)326-3584		(888)649-5968		(888)649-5968		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3449	005	0	1	01	01	H3449_005_0	9		1	08/14/2014	2015.01	08/14/2014 03:52:02 PM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time			08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Enhanced (HMO)	01	01		1			H3449	005	0	2015	Select North Carolina Counties		2	44086	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2
H3449	012	0	1	01	01	H3449_012_0	6		1	08/14/2014	2015.01	08/14/2014 03:52:17 PM Eastern Daylight Time	07/28/2014 02:03:12 PM Eastern Daylight Time				08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Medical Only (HMO)	01	01		1			H3449	012	0	2015	Select North Carolina Counties		2	13321	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										2					2					2
H3449	013	0	1	01	01	H3449_013_0	9		1	08/14/2014	2015.01	08/14/2014 03:52:28 PM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time	08/06/2014 11:22:32 AM Eastern Daylight Time			08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Standard (HMO)	01	01		1			H3449	013	0	2015	Select North Carolina Counties		2	31583	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2
H3449	016	0	1	01	01	H3449_016_0	8		1	08/14/2014	2015.01	08/14/2014 03:52:48 PM Eastern Daylight Time	08/06/2014 11:22:33 AM Eastern Daylight Time	08/06/2014 11:22:33 AM Eastern Daylight Time			08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO Essential (HMO)	01	01		1			H3449	016	0	2015	Selected North Carolina counties		2	5555	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		2					2					2
H3449	801	0	1	01	01	H3449_801_0	4		1	08/12/2014	2015.01	08/12/2014 07:26:46 PM Eastern Daylight Time	07/30/2014 11:19:52 AM Eastern Daylight Time				08/12/2014 07:39:18 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO EGWP (HMO)	01	01		1			H3449	801	0	2015	North Carolina Employer Groups		1	633	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140		1	2		2		1					2
H3449	805	0	1	01	01	H3449_805_0	5		1	08/14/2014	2015.01	08/14/2014 03:34:34 PM Eastern Daylight Time	07/30/2014 11:19:52 AM Eastern Daylight Time				08/14/2014 03:58:01 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare HMO EGWP Medical Only (HMO)	01	01		1			H3449	805	0	2015	North Carolina Employer Groups		1	0	2			2							www.bcbsnc.com/medicare	http://www.bcbsnc.com/content/medicare/formulary-home.htm	https://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC	(888)310-4110		(888)310-4110		(800)665-8037		(800)665-8037										(888)451-9957		(888)451-9957		(800)922-3140		(800)922-3140										1	1	011111111000100111110111011100000010	2		1					2
H3456	001	0	1	01	01	H3456_001_0	2		1	05/30/2014	2015.02	05/30/2014 04:24:43 PM Central Daylight Time	08/04/2014 02:46:08 PM Central Daylight Time	07/31/2014 03:27:51 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3456	001	0	2015	Select Counties in North Carolina		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3456	010	0	1	01	01	H3456_010_0	6		1	07/18/2014	2015.02	07/18/2014 09:28:51 AM Central Daylight Time	08/12/2014 09:42:53 AM Central Daylight Time	07/31/2014 03:27:55 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3456	010	0	2015	Select Counties in North Carolina		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3456	016	0	1	01	01	H3456_016_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:02:19 AM Central Daylight Time	08/04/2014 04:05:33 PM Central Daylight Time	07/31/2014 03:16:07 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3456	016	0	2015	Select Counties in North Carolina		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3456	020	0	1	01	01	H3456_020_0	1		1	05/29/2014	2015.02	05/29/2014 09:21:18 AM Central Daylight Time	05/30/2014 05:27:29 PM Central Daylight Time				05/31/2014 09:02:54 AM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3456	020	0	2015	Select Counties in North Carolina		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H3456	023	0	1	01	01	H3456_023_0	2		1	05/30/2014	2015.02	05/30/2014 04:25:16 PM Central Daylight Time	08/04/2014 02:46:50 PM Central Daylight Time	07/31/2014 03:16:10 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H3456	023	0	2015	Durham and Wake counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3456	026	0	1	01	01	H3456_026_0	2		1	05/30/2014	2015.02	05/30/2014 04:26:04 PM Central Daylight Time	08/04/2014 02:47:25 PM Central Daylight Time	07/31/2014 03:16:13 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3456	026	0	2015	Select Counties in North Carolina		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3456	801	0	1	01	01	H3456_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:11:18 AM Central Daylight Time	05/30/2014 05:29:03 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3456	801	0	2015	Select Counties in North Carolina		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3456	803	0	1	01	01	H3456_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:11:29 AM Central Daylight Time	05/30/2014 05:29:42 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3456	803	0	2015	Select Counties in NC		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3456	804	0	1	01	01	H3456_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:11:36 AM Central Daylight Time	05/30/2014 05:30:15 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3456	804	0	2015	Select counties in NC		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H3456	805	0	2	01	01	H3456_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:11:45 AM Central Daylight Time	05/30/2014 05:30:46 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H3456	805	0	2015	Select counties in NC		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3456	806	0	2	01	01	H3456_806_0	1		1	05/22/2014	2015.01	05/22/2014 09:11:54 AM Central Daylight Time	05/30/2014 05:31:18 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NORTH CAROLINA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		2	2		H3456	806	0	2015	Select counties in NC		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3471	001	0	1	01	01	H3471_001_0	3		1	08/05/2014	2015.01	08/05/2014 10:28:33 AM Central Daylight Time	08/05/2014 06:15:13 PM Central Daylight Time	07/31/2014 04:50:33 PM Central Daylight Time			08/06/2014 01:27:59 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion HMO Rx (HMO)	01	01		1			H3471	001	0	2015	Central Washington		2	4179	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H3471	002	0	1	01	01	H3471_002_0	3		1	08/05/2014	2015.01	08/05/2014 09:25:27 AM Central Daylight Time	08/05/2014 06:15:57 PM Central Daylight Time	07/31/2014 04:50:37 PM Central Daylight Time			08/06/2014 01:27:59 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion Plus HMO Rx (HMO)	01	01		1			H3471	002	0	2015	Central Washington		2	317	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H3471	003	0	1	01	01	H3471_003_0	2		1	07/14/2014	2015.01	07/14/2014 12:33:48 PM Central Daylight Time	05/31/2014 09:29:43 PM Central Daylight Time				07/14/2014 12:42:30 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Health Alliance Medicare Companion HMO (HMO)	01	01		1			H3471	003	0	2015	Central Washington		2	429	2			2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2
H3471	801	0	1	01	01	H3471_801_0	1		1	05/28/2014	2015.01	05/28/2014 04:15:09 PM Central Daylight Time	05/31/2014 09:30:20 PM Central Daylight Time				06/01/2014 07:36:24 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO (HMO)	01	01		1			H3471	801	0	2015	Central Washington		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										1	2		2		1					1
H3471	802	0	1	01	01	H3471_802_0	1		1	05/28/2014	2015.01	05/28/2014 04:15:12 PM Central Daylight Time	05/31/2014 09:30:51 PM Central Daylight Time				06/01/2014 07:36:24 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx (HMO)	01	01		1			H3471	802	0	2015	Central Washington		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		1	2		2		1					1
H3471	803	0	1	01	01	H3471_803_0	1		1	05/28/2014	2015.01	05/28/2014 04:15:18 PM Central Daylight Time	05/31/2014 09:31:29 PM Central Daylight Time				06/01/2014 07:36:24 PM Central Daylight Time	HEALTH ALLIANCE NORTHWEST HEALTH PLAN, INC.	Health Alliance Medicare	www.healthalliancemedicare.org	Medicare Employer HMO Rx - non calendar year (HMO)	01	01		1			H3471	803	0	2015	Central Washington		1	1	1	1		2							www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(877)750-3350		(877)750-3350		(877)561-1463		(877)561-1463		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		1	2		2		1					1
H3473	001	0	1	20	08	H3473_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:12:17 PM Eastern Daylight Time		05/27/2014 12:29:52 PM Eastern Daylight Time			05/28/2014 01:23:25 PM Eastern Daylight Time	CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC.	Blue Ridge PACE	www.riversideonline.com	Blue Ridge PACE Dual (PACE)	08	20		1			H3473	001	0	2015	Blue Ridge PACE Dual		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569												
H3473	002	0	1	20	08	H3473_002_0	1		1	05/28/2014	2015.01	05/28/2014 01:13:02 PM Eastern Daylight Time		05/27/2014 12:37:24 PM Eastern Daylight Time			05/28/2014 01:23:25 PM Eastern Daylight Time	CHARLOTTESVILLE AREA RETIREMENT SERVICES, INC.	Blue Ridge PACE	www.riversideonline.com	Blue Ridge PACE Medicare Only (PACE)	08	20		1			H3473	002	0	2015	Blue Ridge PACE Medicare Only		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569										(800)675-6368		(434)906-0569		(800)675-6368		(434)906-0569												
H3480	001	0	1	48	05	H3480_001_0	9		1	08/20/2014	2015.02	08/20/2014 11:58:23 AM Eastern Daylight Time					08/20/2014 01:07:05 PM Eastern Daylight Time	HUMANA HEALTH PLAN, INC.	Humana Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus Integrated H3480-001 (Medicare-Medicaid Plan)	05	48		1			H3480	001	0	2015	Select Counties in Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(855)280-4002		(855)280-4002		(800)833-2364		(800)833-2364		(855)280-4002		(855)280-4002		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3493	001	0	1	20	08	H3493_001_0	1		1	05/27/2014	2015.01	05/27/2014 05:24:34 PM Central Daylight Time		05/21/2014 11:30:26 AM Central Daylight Time			05/27/2014 05:27:09 PM Central Daylight Time	LIFE AT LOURDES, INC.	LIFE at Lourdes	https://www.lourdesnet.org/programs-and-services/l	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	001	0	2015	LIFE at Lourdes		2		2			2								www.lourdesnet.org	www.lourdesnet.org									(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355												
H3493	002	0	1	20	08	H3493_002_0	1		1	05/27/2014	2015.01	05/27/2014 05:25:03 PM Central Daylight Time		05/21/2014 11:37:42 AM Central Daylight Time			05/27/2014 05:27:09 PM Central Daylight Time	LIFE AT LOURDES, INC.	LIFE at Lourdes	www.lourdesmed.org	LIFE at Lourdes, Inc (PACE)	08	20		1			H3493	002	0	2015	LIFE at Lourdes		2		2			2								www.lourdesnet.org	www.lourdesnet.org									(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355										(856)675-3355		(856)675-3355		(856)675-3355		(856)675-3355												
H3517	001	0	1	20	08	H3517_001_0	1		1	08/19/2014	2015.01	08/19/2014 08:36:17 AM Pacific Daylight Time		08/15/2014 12:04:51 PM Pacific Daylight Time			08/19/2014 08:38:25 AM Pacific Daylight Time	HUMBOLDT SENIOR RESOURCE CENTER, INC.	Redwood Coast PACE	www.humsenior.org	Redwood  Coast PACE-Dual (PACE)	08	20		1			H3517	001	0	2015	Redwood Coast PACE-Dual		2		2			2							n/a	www.pharmastarpbm.com	www.pharmastarpbm.com									(707)443-9747	1229	(707)443-9747	1229	(707)443-9747		(707)443-9747										(707)443-9747	1229	(707)443-9747	1229	(707)443-9747		(707)443-9747												
H3517	002	0	1	20	08	H3517_002_0	1		1	08/19/2014	2015.01	08/19/2014 08:36:36 AM Pacific Daylight Time		08/15/2014 12:22:13 PM Pacific Daylight Time			08/19/2014 08:38:25 AM Pacific Daylight Time	HUMBOLDT SENIOR RESOURCE CENTER, INC.	Redwood Coast PACE	www.humsenior.org	Redwood Coast PACE-Medicare Only (PACE)	08	20		1			H3517	002	0	2015	Redwood Coast PACE-Medicare Only		2		2			2								www.pharmastarpbm.com	www.pharmastarpbm.com									(707)443-9747	1229	(707)443-9747	1229	(707)443-9747		(707)443-9747										(707)443-9747	1229	(707)443-9747	1229	(707)443-9747		(707)443-9747												
H3528	001	0	1	01	01	H3528_001_0	6		1	08/05/2014	2015.02	08/05/2014 05:21:45 PM Eastern Daylight Time	08/05/2014 04:51:30 PM Eastern Daylight Time	08/05/2014 04:51:30 PM Eastern Daylight Time			08/06/2014 07:59:12 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Prime 1 (HMO)	01	01		1			H3528	001	0	2015	State of Connecticut		2	30300	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2
H3528	002	0	1	01	01	H3528_002_0	6		1	08/07/2014	2015.02	08/07/2014 08:19:14 PM Eastern Daylight Time	08/07/2014 08:15:53 PM Eastern Daylight Time	08/07/2014 08:15:54 PM Eastern Daylight Time			08/07/2014 08:24:00 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Prime 3 (HMO)	01	01		1			H3528	002	0	2015	State of Connecticut		2	5700	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2
H3528	003	0	1	01	01	H3528_003_0	3		1	07/11/2014	2015.02	07/11/2014 02:16:14 PM Eastern Daylight Time	06/01/2014 05:34:26 PM Eastern Daylight Time				07/11/2014 02:41:54 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Prime 4 (HMO)	01	01		1			H3528	003	0	2015	State of Connecticut		2	1000	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										2					2					2
H3528	006	0	1	02	01	H3528_006_0	6		1	07/11/2014	2015.02	07/11/2014 02:16:29 PM Eastern Daylight Time	08/05/2014 05:10:43 PM Eastern Daylight Time	08/05/2014 05:10:43 PM Eastern Daylight Time			08/06/2014 07:59:12 AM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Option 1 (HMO-POS)	01	02		1			H3528	006	0	2015	State of Connecticut		2	700	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2
H3528	008	0	1	02	01	H3528_008_0	8		1	08/07/2014	2015.02	08/07/2014 08:19:44 PM Eastern Daylight Time	08/07/2014 08:15:54 PM Eastern Daylight Time	08/07/2014 08:15:54 PM Eastern Daylight Time			08/07/2014 08:24:00 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP Option 3 (HMO-POS)	01	02		1			H3528	008	0	2015	State of Connecticut		2	5500	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		2					2					2
H3528	801	0	1	01	01	H3528_801_0	4		1	06/01/2014	2015.02	06/01/2014 11:27:33 AM Eastern Daylight Time	06/02/2014 04:16:53 PM Eastern Daylight Time				06/02/2014 04:21:15 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO)	01	01		1			H3528	801	0	2015	State of Connecticut		1	790	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		1	1	011100111000100101111111011100000100	2		1					1
H3528	805	0	1	01	01	H3528_805_0	4		1	06/01/2014	2015.02	06/01/2014 11:27:24 AM Eastern Daylight Time	06/11/2014 11:22:20 AM Eastern Daylight Time				06/12/2014 01:08:25 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO)	01	01		1			H3528	805	0	2015	State of Connecticut		1	250	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										1	1	011100111000100101111111011100000100	2		1					1
H3528	806	0	1	02	01	H3528_806_0	5		1	06/01/2014	2015.02	06/01/2014 11:34:11 AM Eastern Daylight Time	06/11/2014 11:22:18 AM Eastern Daylight Time				06/12/2014 01:08:25 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO-POS)	01	02		1			H3528	806	0	2015	State of Connecticut		1	330	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710		1	1	011100111000100101111111011100000100	2		1	2		2		1
H3528	807	0	1	02	01	H3528_807_0	4		1	06/01/2014	2015.02	06/01/2014 11:34:22 AM Eastern Daylight Time	07/09/2014 12:53:00 PM Eastern Daylight Time				07/09/2014 12:57:15 PM Eastern Daylight Time	CONNECTICARE, INC.	ConnectiCare, Inc.	www.connecticare.com	ConnectiCare VIP (HMO-POS)	01	02		1			H3528	807	0	2015	State of Connecticut		1	0	2			2							www.connecticare.com	www.connecticare.com	www.connecticare.com	(800)224-2273		(800)224-2273		(877)224-8220		(877)224-8220										(800)842-9710		(800)842-9710		(800)842-9710		(800)842-9710										1	1	011100111000100101111111011100000100	2		1	2		2		1
H3533	001	0	1	01	01	H3533_001_0	3		1	08/02/2014	2015.02	08/02/2014 09:17:42 AM Eastern Daylight Time	08/04/2014 11:53:52 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-001 (HMO)	01	01		1			H3533	001	0	2015	Madison, Oneida, Onondaga and Oswego counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	002	0	1	01	01	H3533_002_0	5	2	1	07/10/2014	2015.02	07/10/2014 01:30:05 PM Eastern Daylight Time	08/04/2014 11:53:20 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H3533-002 (HMO SNP)	01	01		1			H3533	002	0	2015	Select Counties in New York		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	004	0	1	01	01	H3533_004_0	5	2	1	07/10/2014	2015.02	07/10/2014 01:35:49 PM Eastern Daylight Time	08/04/2014 11:50:54 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H3533-004 (HMO SNP)	01	01		1			H3533	004	0	2015	Kings, New York, Queens and Richmond counties		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	005	0	1	01	01	H3533_005_0	3		1	08/02/2014	2015.02	08/02/2014 09:22:09 AM Eastern Daylight Time	08/04/2014 12:04:28 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-005 (HMO)	01	01		1			H3533	005	0	2015	Kings County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	006	0	1	01	01	H3533_006_0	3		1	08/02/2014	2015.02	08/02/2014 09:47:44 AM Eastern Daylight Time	08/04/2014 11:52:47 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-006 (HMO)	01	01		1			H3533	006	0	2015	Capital District area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	007	0	1	01	01	H3533_007_0	4		1	08/02/2014	2015.02	08/02/2014 09:56:27 AM Eastern Daylight Time	08/06/2014 11:59:30 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 01:47:59 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-007 (HMO)	01	01		1			H3533	007	0	2015	Richmond County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	009	0	1	01	01	H3533_009_0	3		1	08/02/2014	2015.02	08/02/2014 10:00:02 AM Eastern Daylight Time	08/04/2014 11:48:07 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-009 (HMO)	01	01		1			H3533	009	0	2015	Queens County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	010	0	1	01	01	H3533_010_0	4		1	07/10/2014	2015.02	07/10/2014 01:58:57 PM Eastern Daylight Time	08/04/2014 12:05:02 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-010 (HMO)	01	01		1			H3533	010	0	2015	Nassau and Suffolk (partial) counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	013	0	1	01	01	H3533_013_0	3		1	07/10/2014	2015.02	07/10/2014 02:00:47 PM Eastern Daylight Time	08/04/2014 12:00:22 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-013 (HMO)	01	01		1			H3533	013	0	2015	Select Counties in New York		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	016	0	1	01	01	H3533_016_0	3		1	08/02/2014	2015.02	08/02/2014 09:11:46 AM Eastern Daylight Time	08/04/2014 12:02:40 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-016 (HMO)	01	01		1			H3533	016	0	2015	Bronx County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	017	0	1	01	01	H3533_017_0	3		1	08/02/2014	2015.02	08/02/2014 09:13:18 AM Eastern Daylight Time	08/04/2014 12:03:17 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-017 (HMO)	01	01		1			H3533	017	0	2015	New York County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	018	0	1	01	01	H3533_018_0	5	2	1	07/10/2014	2015.02	07/10/2014 02:06:33 PM Eastern Daylight Time	08/04/2014 12:01:57 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H3533-018 (HMO SNP)	01	01		1			H3533	018	0	2015	Bronx County		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	019	0	1	01	01	H3533_019_0	3		1	07/10/2014	2015.02	07/10/2014 02:12:49 PM Eastern Daylight Time	08/04/2014 12:01:18 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Gold Plus H3533-019 (HMO)	01	01		1			H3533	019	0	2015	Nassau and Suffolk counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3533	802	0	1	01	01	H3533_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:43:04 PM Eastern Daylight Time	07/14/2014 11:04:01 AM Eastern Daylight Time				07/14/2014 01:58:48 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H3533	802	0	2015	Select Counties in NY		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H3533	803	0	1	01	01	H3533_803_0	2		1	05/23/2014	2015.02	05/23/2014 02:43:50 PM Eastern Daylight Time	07/14/2014 11:04:43 AM Eastern Daylight Time				07/14/2014 01:58:48 PM Eastern Daylight Time	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Humana Health Company of New York, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H3533	803	0	2015	Select Counties in NY		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H3536	002	0	1	01	01	H3536_002_0	13		1	07/23/2014	2015.01	07/23/2014 05:57:35 PM Pacific Daylight Time	08/05/2014 11:52:14 PM Pacific Daylight Time	08/01/2014 02:31:03 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H3536	002	0	2015	Hillsborough and Rockingham Counties		2	647	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2473		(855)310-2473		(800)797-6419		(800)797-6419		(855)310-2473		(855)310-2473		(800)797-6419		(800)797-6419		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3536	801	0	1	01	01	H3536_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:36:40 AM Pacific Daylight Time	07/15/2014 01:21:48 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H3536	801	0	2015	Select counties in New Hampshire		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H3536	802	0	1	01	01	H3536_802_0	8		1	05/31/2014	2015.01	05/31/2014 11:36:52 AM Pacific Daylight Time	07/15/2014 01:21:54 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	MATTHEW THORNTON HEALTH PLAN, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H3536	802	0	2015	Select Counties in New Hampshire		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)251-8824		(855)251-8824		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H3597	001	0	1	01	01	H3597_001_0	4		1	08/03/2014	2015.01	08/03/2014 11:36:43 AM Eastern Daylight Time	08/04/2014 04:55:46 PM Eastern Daylight Time	08/01/2014 09:38:39 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3597	001	0	2015	Southern Maine		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3597	002	0	1	01	01	H3597_002_0	4		1	08/03/2014	2015.01	08/03/2014 11:41:12 AM Eastern Daylight Time	08/04/2014 04:57:02 PM Eastern Daylight Time	08/01/2014 09:38:49 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3597	002	0	2015	Southern Maine		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3597	005	0	1	01	01	H3597_005_0	3		1	08/03/2014	2015.01	08/03/2014 11:44:07 AM Eastern Daylight Time	08/04/2014 04:58:56 PM Eastern Daylight Time	08/01/2014 09:38:59 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3597	005	0	2015	Penobscot, Oxford and Piscataquis counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3597	801	0	1	01	01	H3597_801_0	1		1	05/23/2014	2015.01	05/23/2014 12:38:12 PM Eastern Daylight Time	05/30/2014 09:33:16 PM Eastern Daylight Time				05/31/2014 10:46:50 AM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3597	801	0	2015	Maine		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H3597	802	0	1	01	01	H3597_802_0	1		1	05/23/2014	2015.01	05/23/2014 12:40:04 PM Eastern Daylight Time	05/30/2014 09:37:44 PM Eastern Daylight Time				05/31/2014 10:46:50 AM Eastern Daylight Time	AETNA HEALTH, INC. (ME)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3597	802	0	2015	Maine		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H3613	001	0	1	20	08	H3613_001_0	1		1	05/19/2014	2015.01	05/19/2014 10:39:41 AM Eastern Daylight Time		05/19/2014 10:29:48 AM Eastern Daylight Time			05/20/2014 11:49:49 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Dual Eligibles (PACE)	08	20		1			H3613	001	0	2015	McGregor PACE Cuyahoga County		2		2			2								http://www.catamaranrx.com/	http://www.catamaranrx.com/									(216)791-3580		(216)791-3580		(216)791-3580		(216)791-3580										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223												
H3613	002	0	1	20	08	H3613_002_0	1		1	05/19/2014	2015.01	05/19/2014 10:40:30 AM Eastern Daylight Time		05/19/2014 10:29:48 AM Eastern Daylight Time			05/20/2014 11:49:49 AM Eastern Daylight Time	MCGREGOR PACE	McGregor PACE	http://www.mcgregorpace.org/	McGregor PACE Medicare Only Eligibles (PACE)	08	20		1			H3613	002	0	2015	McGregor PACE Cuyahoga County		2		2			2								http://www.catamaranrx.com/	http://www.catamaranrx.com/									(216)791-3580		(216)791-3580		(216)791-3580		(216)791-3580										(800)325-2223		(800)325-2223		(800)325-2223		(800)325-2223												
H3623	001	0	1	01	01	H3623_001_0	5		1	08/03/2014	2015.01	08/03/2014 04:38:27 PM Eastern Daylight Time	08/04/2014 07:46:18 PM Eastern Daylight Time	08/01/2014 09:39:10 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3623	001	0	2015	Columbus OH Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3623	004	0	1	01	01	H3623_004_0	5		1	08/03/2014	2015.01	08/03/2014 04:40:01 PM Eastern Daylight Time	08/04/2014 07:48:00 PM Eastern Daylight Time	08/01/2014 09:39:20 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3623	004	0	2015	Cleveland and NE OH Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3623	018	0	1	01	01	H3623_018_0	4		1	08/03/2014	2015.01	08/03/2014 04:41:14 PM Eastern Daylight Time	08/04/2014 07:52:02 PM Eastern Daylight Time	08/01/2014 09:39:30 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3623	018	0	2015	Toledo and Cincinnati Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3623	020	0	1	01	01	H3623_020_0	3		1	08/03/2014	2015.01	08/03/2014 04:42:43 PM Eastern Daylight Time	08/05/2014 11:31:34 AM Eastern Daylight Time	08/01/2014 09:39:41 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3623	020	0	2015	Dayton		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3623	801	0	1	01	01	H3623_801_0	3		1	05/23/2014	2015.01	05/23/2014 12:42:21 PM Eastern Daylight Time	07/17/2014 10:09:10 PM Eastern Daylight Time				07/24/2014 03:45:20 PM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3623	801	0	2015	Ohio		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H3623	802	0	1	01	01	H3623_802_0	2		1	05/23/2014	2015.01	05/23/2014 12:43:47 PM Eastern Daylight Time	06/01/2014 08:54:00 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH,  INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3623	802	0	2015	Ohio		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H3653	004	0	1	01	01	H3653_004_0	9		1	05/30/2014	2015.01	05/30/2014 06:36:40 PM Eastern Daylight Time	08/01/2014 08:42:50 AM Eastern Daylight Time	07/31/2014 05:42:05 PM Eastern Daylight Time			08/01/2014 03:38:37 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical and Drug (HMO)	01	01		1			H3653	004	0	2015	Paramount Elite - Enhanced (NW Ohio / SE Mich)		2	11377	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2
H3653	015	0	1	01	01	H3653_015_0	8		1	05/30/2014	2015.01	05/30/2014 06:37:06 PM Eastern Daylight Time	08/01/2014 08:48:04 AM Eastern Daylight Time	07/31/2014 05:36:45 PM Eastern Daylight Time			08/01/2014 03:38:37 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Standard Medical and Drug (HMO)	01	01		1			H3653	015	0	2015	Paramount Elite - Standard (NW Ohio / SE Mich)		2	1848	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		2					2					2
H3653	018	0	1	01	01	H3653_018_0	6		1	05/30/2014	2015.01	05/30/2014 06:37:37 PM Eastern Daylight Time	07/16/2014 05:19:07 PM Eastern Daylight Time				07/18/2014 03:32:09 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Enhanced Medical Only (HMO)	01	01		1			H3653	018	0	2015	Paramount Elite - Medical Only (NW Ohio / SE Mich)		2	210	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										2					2					2
H3653	803	0	1	01	01	H3653_803_0	4		1	05/30/2014	2015.01	05/30/2014 06:38:31 PM Eastern Daylight Time	07/16/2014 05:21:48 PM Eastern Daylight Time				07/18/2014 03:32:09 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group A/B No Rx (HMO)	01	01		1			H3653	803	0	2015	Paramount Elite - Emp Group A/B No Rx		1	1597	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										1	1	011100011000100101111111011100000100	2		1					1
H3653	806	0	2	01	01	H3653_806_0	4		1	05/30/2014	2015.01	05/30/2014 06:38:51 PM Eastern Daylight Time	07/16/2014 05:20:51 PM Eastern Daylight Time				07/18/2014 03:32:09 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite - Emp Group B only No Rx (HMO)	01	01		2	2		H3653	806	0	2015	Paramount Elite - Emp Group B only No Rx		1	131	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670										2					1					1
H3653	809	0	1	01	01	H3653_809_0	4		1	05/30/2014	2015.01	05/30/2014 06:39:17 PM Eastern Daylight Time	07/16/2014 05:16:22 PM Eastern Daylight Time				07/18/2014 03:32:09 PM Eastern Daylight Time	PARAMOUNT CARE, INC.	Paramount Elite	www.paramounthealthcare.com/medicareplans	Paramount Elite-Emp Group A/B Rx (HMO)	01	01		1			H3653	809	0	2015	Paramount Elite-Emp Group A/B Rx		1	81	2			2							http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	http://www.paramounthealthcare.com/medicareplans	(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(800)462-3589		(419)887-2525		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670		1	1	011100011000100101111111011100000100	2		1					1
H3655	032	0	1	01	01	H3655_032_0	10		1	08/06/2014	2015.01	08/06/2014 10:46:54 AM Eastern Daylight Time	08/06/2014 12:03:05 PM Eastern Daylight Time	08/01/2014 05:31:04 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage Basic (HMO)	01	01		1			H3655	032	0	2015	Select Counties in Ohio		2	103893	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3655	033	0	1	01	01	H3655_033_0	11	2	1	08/05/2014	2015.01	08/05/2014 09:07:56 AM Eastern Daylight Time	08/06/2014 02:20:36 PM Eastern Daylight Time	08/06/2014 04:05:08 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H3655	033	0	2015	Select Counties in Ohio		2	1495	2			1	3		1	1			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3655	034	0	1	01	01	H3655_034_0	11		1	07/14/2014	2015.01	07/14/2014 01:41:29 PM Central Daylight Time	08/06/2014 02:52:23 AM Eastern Daylight Time	08/01/2014 05:31:04 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage Plus (HMO)	01	01		1			H3655	034	0	2015	Select Counties in Ohio		2	3130	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3655	801	0	1	01	01	H3655_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:37:20 AM Pacific Daylight Time	07/15/2014 01:21:59 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	801	0	2015	Ohio		1	2262	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H3655	803	0	1	01	01	H3655_803_0	8		1	05/31/2014	2015.01	05/31/2014 11:37:36 AM Pacific Daylight Time	07/15/2014 01:22:04 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	803	0	2015	Ohio		1	28	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H3655	804	0	1	01	01	H3655_804_0	8		1	05/31/2014	2015.01	05/31/2014 11:37:46 AM Pacific Daylight Time	07/15/2014 01:22:08 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Senior Advantage (HMO)	01	01		1			H3655	804	0	2015	Ohio		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H3659	003	0	1	01	01	H3659_003_0	2		1	05/28/2014	2015.02	05/28/2014 03:45:12 PM Central Daylight Time	08/04/2014 02:48:13 PM Central Daylight Time	07/31/2014 03:16:17 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3659	003	0	2015	Cleveland area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3659	031	0	1	01	01	H3659_031_0	2		1	05/23/2014	2015.02	05/23/2014 01:35:10 PM Central Daylight Time	08/04/2014 02:49:26 PM Central Daylight Time	07/31/2014 03:16:20 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3659	031	0	2015	Select Counties in Ohio and Kentucky		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3659	054	0	1	01	01	H3659_054_0	1		1	05/23/2014	2015.02	05/23/2014 01:35:20 PM Central Daylight Time	05/30/2014 05:33:33 PM Central Daylight Time				05/31/2014 11:30:54 AM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H3659	054	0	2015	Select Ohio Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H3659	056	0	1	01	01	H3659_056_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:02:30 AM Central Daylight Time	08/04/2014 04:02:18 PM Central Daylight Time	07/31/2014 03:16:24 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H3659	056	0	2015	Select Counties in Ohio		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3659	058	0	1	02	01	H3659_058_0	6		1	07/18/2014	2015.02	07/18/2014 09:34:50 AM Central Daylight Time	08/12/2014 09:43:42 AM Central Daylight Time	07/31/2014 03:16:28 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H3659	058	0	2015	Select Counties in Ohio		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3659	062	0	1	01	01	H3659_062_0	2		1	05/23/2014	2015.02	05/23/2014 01:35:29 PM Central Daylight Time	08/04/2014 02:55:14 PM Central Daylight Time	07/31/2014 03:16:31 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H3659	062	0	2015	Cincinnati Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3659	801	0	1	01	01	H3659_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:12:08 AM Central Daylight Time	05/30/2014 05:34:37 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3659	801	0	2015	OH Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3659	802	0	1	01	01	H3659_802_0	1		1	05/22/2014	2015.01	05/22/2014 09:12:20 AM Central Daylight Time	05/30/2014 05:35:09 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3659	802	0	2015	OH Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H3659	803	0	1	01	01	H3659_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:12:29 AM Central Daylight Time	05/30/2014 05:35:42 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OHIO, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3659	803	0	2015	OH Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3660	028	0	1	02	01	H3660_028_0	14		1	07/14/2014	2015.01	07/14/2014 03:35:55 PM Eastern Daylight Time	08/04/2014 07:23:18 PM Eastern Daylight Time	08/04/2014 06:30:40 PM Eastern Daylight Time			08/07/2014 08:56:21 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Emerald (HMO-POS)	01	02		1			H3660	028	0	2015	Northeast Ohio		2	3560	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	029	0	1	02	01	H3660_029_0	15		1	08/05/2014	2015.01	08/05/2014 09:40:47 AM Eastern Daylight Time	08/04/2014 07:22:48 PM Eastern Daylight Time	08/04/2014 06:30:22 PM Eastern Daylight Time			08/07/2014 08:59:25 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	029	0	2015	Northeast Ohio		2	9648	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	044	0	1	01	01	H3660_044_0	15		1	08/05/2014	2015.01	08/05/2014 09:57:00 AM Eastern Daylight Time	08/04/2014 07:21:06 PM Eastern Daylight Time	08/04/2014 06:29:54 PM Eastern Daylight Time			08/07/2014 09:02:35 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	044	0	2015	Northeast Ohio		2	12297	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	047	0	1	01	01	H3660_047_0	13		1	08/05/2014	2015.01	08/05/2014 10:02:30 AM Eastern Daylight Time	08/04/2014 07:20:44 PM Eastern Daylight Time	08/04/2014 06:29:34 PM Eastern Daylight Time			08/07/2014 09:04:23 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Ruby (HMO)	01	01		1			H3660	047	0	2015	Northwest Ohio		2	1860	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	048	0	1	02	01	H3660_048_0	13		1	08/05/2014	2015.01	08/05/2014 09:41:25 AM Eastern Daylight Time	08/04/2014 07:24:26 PM Eastern Daylight Time	08/04/2014 06:28:44 PM Eastern Daylight Time			08/07/2014 09:06:17 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Sapphire (HMO-POS)	01	02		1			H3660	048	0	2015	Northwest Ohio		2	494	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	049	0	1	01	01	H3660_049_0	13		1	08/05/2014	2015.01	08/05/2014 10:05:59 AM Eastern Daylight Time	08/04/2014 07:23:58 PM Eastern Daylight Time	08/04/2014 06:28:28 PM Eastern Daylight Time			08/07/2014 09:07:55 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	049	0	2015	Northwest Ohio		2	280	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	050	0	1	01	01	H3660_050_0	8		1	08/05/2014	2015.01	08/05/2014 10:25:59 AM Eastern Daylight Time	08/04/2014 07:23:36 PM Eastern Daylight Time	08/04/2014 06:28:10 PM Eastern Daylight Time			08/06/2014 01:18:55 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Topaz (HMO)	01	01		1			H3660	050	0	2015	Northeast Ohio		2	7198	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	801	0	1	01	01	H3660_801_0	11		1	04/24/2014	2015.01	04/24/2014 12:24:29 PM Eastern Daylight Time	06/26/2014 01:12:36 PM Eastern Daylight Time				07/02/2014 05:31:20 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan with Part D (HMO)	01	01		1			H3660	801	0	2015	Nationwide Service Area		1	1246	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	802	0	1	01	01	H3660_802_0	8		1	04/24/2014	2015.01	04/24/2014 01:51:49 PM Eastern Daylight Time	06/25/2014 05:18:10 PM Eastern Daylight Time				06/26/2014 10:38:44 AM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO)	01	01		1			H3660	802	0	2015	Nationwide Service Area		1	18	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440										(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750										2					2					2
H3660	805	0	1	02	01	H3660_805_0	10		1	04/24/2014	2015.01	04/24/2014 02:04:31 PM Eastern Daylight Time	06/26/2014 01:11:56 PM Eastern Daylight Time				07/02/2014 05:34:20 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan with Part D (HMO-POS)	01	02		1			H3660	805	0	2015	Nationwide Service Area		1	1023	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H3660	806	0	1	02	01	H3660_806_0	9		1	04/24/2014	2015.01	04/24/2014 02:06:38 PM Eastern Daylight Time	06/26/2014 01:11:24 PM Eastern Daylight Time				07/02/2014 05:38:44 PM Eastern Daylight Time	SUMMACARE INC.	SummaCare Medicare Advantage Plans	www.summacare.com/medicare	SummaCare Medicare Employer Plan without Part D (HMO-POS)	01	02		1			H3660	806	0	2015	Nationwide Service Area		1	13	2			2							www.summacare.com/medicare	http://medicare.summacare.com/member/drug_benefits/FindaDrug.aspx	www.summacare.com/medicare	(800)996-6250		(330)996-8885		(888)464-8440		(330)996-8440										(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750										2					2					2
H3664	014	0	1	02	01	H3664_014_0	3		1	07/21/2014	2015.02	07/21/2014 12:00:00 PM Eastern Daylight Time	05/31/2014 04:01:45 PM Eastern Daylight Time				07/21/2014 12:02:15 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Basic - MA Only (HMO-POS)	01	02		1			H3664	014	0	2015	Operating in 13 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										2					2					2
H3664	017	0	1	02	01	H3664_017_0	6		1	08/15/2014	2015.02	08/15/2014 11:27:54 AM Eastern Daylight Time	08/14/2014 02:12:39 PM Eastern Daylight Time	08/04/2014 02:14:20 PM Eastern Daylight Time			08/15/2014 11:28:49 AM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Plus (HMO-POS)	01	02		1			H3664	017	0	2015	Operating in 13 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2
H3664	020	0	1	02	01	H3664_020_0	4		1	08/04/2014	2015.02	08/04/2014 01:39:15 PM Eastern Daylight Time	08/04/2014 02:14:21 PM Eastern Daylight Time	08/04/2014 02:14:11 PM Eastern Daylight Time			08/04/2014 04:43:29 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Classic (HMO-POS)	01	02		1			H3664	020	0	2015	Operating in 13 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2
H3664	021	0	1	02	01	H3664_021_0	4		1	08/04/2014	2015.02	08/04/2014 10:13:35 AM Eastern Daylight Time	08/04/2014 02:14:16 PM Eastern Daylight Time	08/04/2014 02:14:17 PM Eastern Daylight Time			08/04/2014 04:43:29 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Aultimate (HMO-POS)	01	02		1			H3664	021	0	2015	Operating in 13 counties in Northeastern Ohio		2		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		2					2					2
H3664	801	0	1	02	01	H3664_801_0	2		1	07/14/2014	2015.02	07/14/2014 11:42:17 AM Eastern Daylight Time	05/31/2014 04:01:41 PM Eastern Daylight Time				07/14/2014 01:33:55 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO  - CY (HMO-POS)	01	02		1			H3664	801	0	2015	All Ohio Counties		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	011000000000000001000000011000000000	2		1	2		2		1
H3664	802	0	1	02	01	H3664_802_0	2		1	07/14/2014	2015.02	07/14/2014 11:42:36 AM Eastern Daylight Time	05/31/2014 04:01:41 PM Eastern Daylight Time				07/14/2014 01:33:55 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO MA-Only (HMO-POS)	01	02		1			H3664	802	0	2015	All Ohio Counties		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										1	1	011000000000000001000000011000000000	2		1	2		2		1
H3664	803	0	1	02	01	H3664_803_0	2		1	07/14/2014	2015.02	07/14/2014 11:42:53 AM Eastern Daylight Time	05/31/2014 04:01:42 PM Eastern Daylight Time				07/14/2014 01:33:55 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group - Non CY (HMO-POS)	01	02		1			H3664	803	0	2015	All Ohio Counties		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	011000000000000001000000011000000000	2		1	2		2		1
H3664	805	0	2	02	01	H3664_805_0	1		1	05/12/2014	2015.02	05/12/2014 12:31:03 PM Eastern Daylight Time	05/31/2014 04:01:43 PM Eastern Daylight Time				05/31/2014 04:31:44 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	primetimehealthplan.com	Part B Only MA-PD (HMO-POS)	01	02		2	2		H3664	805	0	2015	Part B Only MA Ohio		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	011000000000000001000000011000000000	2		1	2		2		1
H3664	806	0	2	02	01	H3664_806_0	1		1	05/12/2014	2015.02	05/12/2014 12:31:33 PM Eastern Daylight Time	05/31/2014 04:01:44 PM Eastern Daylight Time				05/31/2014 04:31:44 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	primetimehealthplan.com	Part B Only MA (HMO-POS)	01	02		2	2		H3664	806	0	2015	Part B Only MA Ohio		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424										(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460										1	1	011000000000000001000000011000000000	2		1	2		2		1
H3664	807	0	1	02	01	H3664_807_0	2		1	07/14/2014	2015.02	07/14/2014 11:43:25 AM Eastern Daylight Time	05/31/2014 04:01:44 PM Eastern Daylight Time				07/14/2014 01:33:55 PM Eastern Daylight Time	AULTCARE INSURANCE COMPANY	PrimeTime Health Plan	www.primetimehealthplan.com	PrimeTime Health Plan Employer Group HMO - CY (HMO-POS)	01	02		1			H3664	807	0	2015	All Ohio Counties		1		2			2							www.primetimehealthplan.com	www.primetimehealthplan.com	www.primetimehealthplan.com	(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)577-5084		(330)363-7407		(855)877-1049		(330)363-7424		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		(800)617-7446		(330)363-7460		1	1	011000000000000001000000011000000000	2		1	2		2		1
H3668	005	0	1	01	01	H3668_005_0	5		1	08/06/2014	2015.01	08/06/2014 11:56:49 AM Eastern Daylight Time	08/04/2014 12:46:00 PM Eastern Daylight Time	08/06/2014 11:23:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Classic Preferred (HMO)	01	01		1			H3668	005	0	2015	Greater Central Ohio and Dayton Area		2	28811	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3668	011	0	1	01	01	H3668_011_0	4		1	08/06/2014	2015.01	08/06/2014 10:46:32 AM Eastern Daylight Time	08/04/2014 12:45:00 PM Eastern Daylight Time	08/06/2014 11:23:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Essential Care (HMO)	01	01		1			H3668	011	0	2015	Greater Central Ohio and Dayton Area		2	6503	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3668	013	0	1	01	01	H3668_013_0	4		1	07/15/2014	2015.01	07/15/2014 10:18:09 AM Eastern Daylight Time	07/24/2014 11:17:17 AM Eastern Daylight Time				07/25/2014 07:00:57 AM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Medical Only (HMO)	01	01		1			H3668	013	0	2015	Greater Central Ohio and Dayton Area		2	600	1	1		2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										2					2					2
H3668	014	0	1	01	01	H3668_014_0	4		1	08/01/2014	2015.01	08/01/2014 05:02:03 PM Eastern Daylight Time	08/04/2014 01:38:00 PM Eastern Daylight Time	08/06/2014 11:22:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southeast OH Classic Preferred (HMO)	01	01		1			H3668	014	0	2015	Southeast Ohio		2	1800	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3668	015	0	1	01	01	H3668_015_0	4		1	08/01/2014	2015.01	08/01/2014 04:18:56 PM Eastern Daylight Time	08/04/2014 01:42:00 PM Eastern Daylight Time	08/06/2014 11:22:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southeast OH Essential Care (HMO)	01	01		1			H3668	015	0	2015	Southeast Ohio		2	1800	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3668	016	0	1	01	01	H3668_016_0	4		1	08/01/2014	2015.01	08/01/2014 05:10:38 PM Eastern Daylight Time	08/04/2014 12:44:00 PM Eastern Daylight Time	08/06/2014 11:22:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southwest OH Classic Preferred (HMO)	01	01		1			H3668	016	0	2015	Greater Cincinnati and Champaign County		2	900	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3668	017	0	1	01	01	H3668_017_0	4		1	08/01/2014	2015.01	08/01/2014 04:22:16 PM Eastern Daylight Time	08/04/2014 12:47:00 PM Eastern Daylight Time	08/06/2014 11:21:00 AM Eastern Daylight Time			08/06/2014 02:47:17 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	MediGold Southwest OH Essential Care (HMO)	01	01		1			H3668	017	0	2015	Greater Cincinnati and Champaign County		2	1600	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3668	801	0	1	01	01	H3668_801_0	2		1	05/28/2014	2015.01	05/28/2014 11:11:18 AM Eastern Daylight Time	06/02/2014 09:33:01 AM Eastern Daylight Time				06/02/2014 12:34:30 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Medical Only (HMO)	01	01		1			H3668	801	0	2015	Central, Southeast and Southwest OH		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H3668	802	0	1	01	01	H3668_802_0	3		1	05/28/2014	2015.01	05/28/2014 10:31:10 AM Eastern Daylight Time	06/04/2014 05:52:29 PM Eastern Daylight Time				06/09/2014 05:02:23 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	802	0	2015	Central, Southeast and Southwest OH		1	490	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3668	803	0	1	01	01	H3668_803_0	3		1	05/28/2014	2015.01	05/28/2014 10:33:45 AM Eastern Daylight Time	06/04/2014 05:55:16 PM Eastern Daylight Time				06/09/2014 05:02:23 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Custom (HMO)	01	01		1			H3668	803	0	2015	Central, Southeast and Southwest OH		1	180	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3668	804	0	1	01	01	H3668_804_0	3		1	05/28/2014	2015.01	05/28/2014 10:48:10 AM Eastern Daylight Time	06/04/2014 06:08:21 PM Eastern Daylight Time				06/09/2014 05:02:23 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Classic (HMO)	01	01		1			H3668	804	0	2015	Central, Southeast and Southwest OH		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3668	805	0	1	01	01	H3668_805_0	1		1	05/28/2014	2015.01	05/28/2014 10:51:50 AM Eastern Daylight Time	05/31/2014 06:45:48 PM Eastern Daylight Time				06/01/2014 03:02:01 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southeast OH Medical Only (HMO)	01	01		1			H3668	805	0	2015	Southeast Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001000000001000000000	2		1					1
H3668	806	0	1	01	01	H3668_806_0	1		1	05/28/2014	2015.01	05/28/2014 10:52:59 AM Eastern Daylight Time	05/31/2014 06:46:20 PM Eastern Daylight Time				06/01/2014 03:02:01 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southeast OH Classic (HMO)	01	01		1			H3668	806	0	2015	Southeast Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3668	807	0	1	01	01	H3668_807_0	1		1	05/28/2014	2015.01	05/28/2014 10:53:56 AM Eastern Daylight Time	05/31/2014 06:46:59 PM Eastern Daylight Time				06/01/2014 03:02:01 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southeast OH Custom (HMO)	01	01		1			H3668	807	0	2015	Southeast Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3668	808	0	1	01	01	H3668_808_0	1		1	05/28/2014	2015.01	05/28/2014 10:54:51 AM Eastern Daylight Time	05/31/2014 06:47:28 PM Eastern Daylight Time				06/01/2014 03:02:01 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southwest OH Medical Only (HMO)	01	01		1			H3668	808	0	2015	Southwest Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001000000001000000000	2		1					1
H3668	809	0	1	01	01	H3668_809_0	1		1	05/28/2014	2015.01	05/28/2014 10:55:57 AM Eastern Daylight Time	05/31/2014 06:50:05 PM Eastern Daylight Time				06/01/2014 03:02:01 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southwest OH Classic (HMO)	01	01		1			H3668	809	0	2015	Southwest Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3668	810	0	1	01	01	H3668_810_0	1		1	05/28/2014	2015.01	05/28/2014 10:56:54 AM Eastern Daylight Time	05/31/2014 06:47:57 PM Eastern Daylight Time				06/01/2014 03:02:01 PM Eastern Daylight Time	MOUNT CARMEL HEALTH PLAN, INC.	MediGold	www.medigold.com	EGWP MediGold Southwest OH Custom (HMO)	01	01		1			H3668	810	0	2015	Southwest Ohio		1	1	2			2							www.medigold.com	www.medigold.com	www.medigold.com	(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(800)240-3851		(614)546-3110		(800)964-4525		(800)964-4525		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001000000001000000000	2		1					1
H3672	013	0	1	01	01	H3672_013_0	5		1	08/05/2014	2015.01	08/05/2014 03:32:28 PM Central Daylight Time	08/05/2014 04:20:47 PM Central Daylight Time	08/06/2014 10:04:56 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	HOMETOWN HEALTH PLAN	The Health Plan	www.healthplan.org	SecureCare - Option II (HMO)	01	01		1			H3672	013	0	2015	East Central Ohio		2	3310	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2					2
H3672	014	0	1	01	01	H3672_014_0	3		1	07/22/2014	2015.01	07/22/2014 11:57:01 AM Central Daylight Time	06/02/2014 02:49:57 PM Central Daylight Time				07/22/2014 12:09:07 PM Central Daylight Time	HOMETOWN HEALTH PLAN	The Health Plan	www.healthplan.org	SecureCare - Option I (HMO)	01	01		1			H3672	014	0	2015	East Central Ohio		2	849	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290										(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291										2					2					2
H3672	017	0	1	01	01	H3672_017_0	8	2	1	08/05/2014	2015.01	08/05/2014 03:33:20 PM Central Daylight Time	08/11/2014 11:54:29 AM Central Daylight Time	08/06/2014 10:05:06 AM Central Daylight Time			08/11/2014 01:01:39 PM Central Daylight Time	HOMETOWN HEALTH PLAN	The Health Plan	www.healthplan.org	SecureCare SNP (HMO SNP)	01	01		1			H3672	017	0	2015	East Central Ohio		2		2			1	3		1	4			www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2					1
H3672	018	0	1	01	01	H3672_018_0	4		1	08/05/2014	2015.01	08/05/2014 03:48:13 PM Central Daylight Time	08/05/2014 04:21:31 PM Central Daylight Time	08/06/2014 10:05:20 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	HOMETOWN HEALTH PLAN	The Health Plan	www.healthplan.org	SecureCare - Option IV (HMO)	01	01		1			H3672	018	0	2015	East Central Ohio		2	100	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		2					2					2
H3672	804	0	1	01	01	H3672_804_0	2		1	06/02/2014	2015.01	06/02/2014 11:26:16 AM Central Daylight Time	06/02/2014 03:23:07 PM Central Daylight Time				06/02/2014 05:14:53 PM Central Daylight Time	HOMETOWN HEALTH PLAN	The Health Plan	www.healthplan.org	SecureCare - Employer (HMO)	01	01		1			H3672	804	0	2015	East Central Ohio		1	33	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290										(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291										1	1	011111111111111110111111011111000010	1	011111111111110111111010001	1					1
H3672	805	0	1	01	01	H3672_805_0	2		1	05/28/2014	2015.01	05/28/2014 09:21:43 PM Central Daylight Time	06/02/2014 03:23:28 PM Central Daylight Time				06/02/2014 05:14:53 PM Central Daylight Time	HOMETOWN HEALTH PLAN	The Health Plan	www.healthplan.org	SecureCare - Employer (HMO)	01	01		1			H3672	805	0	2015	East Central Ohio		1	297	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2296		(330)837-6880		(877)236-2290		(877)236-2290		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		(877)236-2291		1	1	011111111111111110111111011111000010	1	011111111111110111111010001	1					1
H3706	001	0	1	01	01	H3706_001_0	8		1	08/05/2014	2015.01	08/05/2014 05:17:34 PM Central Daylight Time	08/04/2014 03:31:55 PM Central Daylight Time	07/31/2014 04:27:16 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	TODAYS OPTIONS OF OKLAHOMA, INC.	Universal American Corp.	www.GenerationsHealthcare.cc	Generations Healthcare Classic (HMO)	01	01		1			H3706	001	0	2015	Central Oklahoma		2		2			2							www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074		(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3706	009	0	1	01	01	H3706_009_0	6		1	07/21/2014	2015.01	07/21/2014 05:14:08 PM Central Daylight Time	07/21/2014 10:05:33 PM Central Daylight Time				07/22/2014 09:31:26 AM Central Daylight Time	TODAYS OPTIONS OF OKLAHOMA, INC.	Universal American Corp.	www.GenerationsHealthcare.cc	Generations Healthcare Value (HMO)	01	01		1			H3706	009	0	2015	Central Oklahoma		2		2			2							www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074										(711)-		(711)-		(711)-		(711)-										2					2					2
H3706	803	0	1	01	01	H3706_803_0	3		1	05/29/2014	2015.01	05/29/2014 11:57:20 AM Central Daylight Time	06/02/2014 06:08:29 PM Central Daylight Time				06/04/2014 11:40:08 AM Central Daylight Time	TODAYS OPTIONS OF OKLAHOMA, INC.	Universal American Corp.	www.GenerationsHealthcare.cc	Generations Healthcare EGHP CY (HMO)	01	01		1			H3706	803	0	2015	Central Oklahoma		1		2			2							www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074		(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H3706	804	0	1	01	01	H3706_804_0	3		1	05/29/2014	2015.01	05/29/2014 11:57:49 AM Central Daylight Time	06/01/2014 08:01:30 PM Central Daylight Time				06/04/2014 11:40:08 AM Central Daylight Time	TODAYS OPTIONS OF OKLAHOMA, INC.	Universal American Corp.	www.GenerationsHealthcare.cc	Generations Healthcare EGHP Non CY (HMO)	01	01		1			H3706	804	0	2015	Central Oklahoma		1		2			2							www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074		(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H3706	807	0	1	01	01	H3706_807_0	3		1	05/29/2014	2015.01	05/29/2014 11:58:11 AM Central Daylight Time	06/01/2014 08:01:48 PM Central Daylight Time				06/04/2014 11:40:08 AM Central Daylight Time	TODAYS OPTIONS OF OKLAHOMA, INC.	Universal American Corp.	www.GenerationsHealthcare.cc	Generations Healthcare EGHP MA only (HMO)	01	01		1			H3706	807	0	2015	Central Oklahoma		1		2			2							www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	www.GenerationsHealthcare.cc	(866)547-3060		(866)547-3060		(866)618-4074		(866)618-4074										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H3708	001	0	1	01	01	H3708_001_0	8		1	06/02/2014	2015.01	06/02/2014 12:15:18 PM Central Daylight Time	08/11/2014 01:51:55 PM Central Daylight Time	07/31/2014 04:27:23 PM Central Daylight Time			08/12/2014 10:48:18 AM Central Daylight Time	SELECTCARE OF OKLAHOMA, INC.	Universal American Corp.	www.SCOklahoma.com	Tribute (HMO SNP)	01	01		1			H3708	001	0	2015	Greater Ardmore Metro Area		2		2			1	1	2	1				www.SCOklahoma.com	www.SCOklahoma.com	www.SCOklahoma.com	(800)817-3515		(800)817-3515		(800)817-3515		(800)817-3515		(800)817-3515		(800)817-3515		(800)817-3515		(800)817-3515		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3749	001	0	1	01	01	H3749_001_0	2		1	05/19/2014	2015.02	05/19/2014 05:29:17 PM Central Daylight Time	08/04/2014 07:15:56 PM Central Daylight Time	07/31/2014 03:16:35 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 1 (HMO)	01	01		1			H3749	001	0	2015	Oklahoma City area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3749	017	0	1	01	01	H3749_017_0	2		1	05/14/2014	2015.02	05/14/2014 10:56:21 AM Central Daylight Time	08/04/2014 02:56:03 PM Central Daylight Time	07/31/2014 03:16:38 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H3749	017	0	2015	Tulsa area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3749	018	0	1	01	01	H3749_018_0	2		1	05/30/2014	2015.02	05/30/2014 02:07:15 PM Central Daylight Time	08/04/2014 02:56:31 PM Central Daylight Time	07/31/2014 03:16:41 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Plan 2 (HMO)	01	01		1			H3749	018	0	2015	Oklahoma City area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3749	801	0	1	01	01	H3749_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:12:42 AM Central Daylight Time	05/30/2014 05:23:22 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	801	0	2015	OK Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H3749	803	0	1	01	01	H3749_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:12:51 AM Central Daylight Time	05/30/2014 05:23:44 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	803	0	2015	OK Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3749	804	0	1	01	01	H3749_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:13:02 AM Central Daylight Time	05/30/2014 05:24:06 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OKLAHOMA, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3749	804	0	2015	OK Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H3755	001	0	1	01	01	H3755_001_0	9		1	08/06/2014	2015.01	08/06/2014 02:04:17 PM Central Daylight Time	08/05/2014 10:33:37 AM Central Daylight Time	08/05/2014 10:33:38 AM Central Daylight Time			08/06/2014 02:27:21 PM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum (HMO)	01	01		1			H3755	001	0	2015	Tulsa Metro Area		2	17500	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2
H3755	002	0	1	01	01	H3755_002_0	6		1	07/21/2014	2015.01	07/21/2014 08:57:26 AM Central Daylight Time	07/18/2014 04:25:17 PM Central Daylight Time				07/21/2014 09:27:47 AM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver (HMO)	01	01		1			H3755	002	0	2015	Tulsa Metro Area		2	2660	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323										(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353										2					2					2
H3755	004	0	1	01	01	H3755_004_0	8		1	08/05/2014	2015.01	08/05/2014 02:37:03 PM Central Daylight Time	08/05/2014 10:33:40 AM Central Daylight Time	08/05/2014 10:33:41 AM Central Daylight Time			08/05/2014 02:57:11 PM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Platinum Plus (HMO)	01	01		1			H3755	004	0	2015	Tulsa Metro Area		2	6095	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2
H3755	005	0	1	01	01	H3755_005_0	8		1	08/06/2014	2015.01	08/06/2014 02:07:22 PM Central Daylight Time	08/05/2014 10:33:42 AM Central Daylight Time	08/05/2014 10:33:43 AM Central Daylight Time			08/06/2014 02:27:21 PM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health Plan Silver Plus (HMO)	01	01		1			H3755	005	0	2015	Tulsa Metro Area		2	380	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2
H3755	801	0	1	01	01	H3755_801_0	5		1	07/11/2014	2015.01	07/11/2014 09:00:44 AM Central Daylight Time	07/18/2014 04:25:22 PM Central Daylight Time				07/18/2014 04:40:42 PM Central Daylight Time	COMMUNITY CARE HMO, INC	CommunityCare Senior Health Plan (HMO)	www.ccok.com	Senior Health EGHP+D (HMO)	01	01		1			H3755	801	0	2015	Tulsa Metro Area		1	2454	2			2							www.ccok.com	http://www.ccok.com/rxformulary?Switch=2	http://www.ccok.com/CommunityCare Medicare/Senior Health Plan.asp	(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)642-8065		(918)594-5323		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		(800)722-0353		2					2					2
H3765	001	0	1	01	01	H3765_001_0	12		1	08/05/2014	2015.02	08/05/2014 05:11:46 PM Pacific Daylight Time	08/06/2014 07:46:02 AM Pacific Daylight Time	07/31/2014 04:38:28 PM Pacific Daylight Time			08/06/2014 02:22:46 PM Pacific Daylight Time	HEARTLAND PLAINS HEALTH	HeartlandPlains Health	www.heartlandplainshealth.com	Classic Plus Rx (HMO)	01	01		1			H3765	001	0	2015	Lincoln - Omaha Metropolitan Areas		2	2500	2			2							www.heartlandplainshealth.com	www.heartlandplainshealth.com	www.heartlandplainshealth.com	(866)792-0184		(253)345-5553		(866)792-0184		(253)345-5553		(866)792-0184		(253)345-5553		(866)792-0184		(253)345-5553		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3794	001	0	1	01	01	H3794_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:29:55 AM Central Daylight Time	08/12/2014 09:46:20 AM Central Daylight Time	07/31/2014 03:16:45 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H3794	001	0	2015	Kenosha and Rock counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3794	002	0	1	01	01	H3794_002_0	3	2	1	08/04/2014	2015.02	08/04/2014 06:31:29 PM Central Daylight Time	08/04/2014 04:06:45 PM Central Daylight Time	07/31/2014 03:16:49 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete LP1 (HMO SNP)	01	01		1			H3794	002	0	2015	Select Counties in Wisconsin		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3794	003	0	1	01	01	H3794_003_0	3		1	07/18/2014	2015.02	07/18/2014 09:29:48 AM Central Daylight Time	08/04/2014 04:07:11 PM Central Daylight Time	07/31/2014 03:16:52 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS WISCONSIN INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Assisted Living Plan (HMO SNP)	01	01		1			H3794	003	0	2015	Eastern Wisconsin various counties		2		2			1	1	2	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3805	001	0	1	01	01	H3805_001_0	4		1	05/30/2014	2015.02	05/30/2014 04:29:40 PM Central Daylight Time	08/04/2014 02:18:53 PM Central Daylight Time	07/31/2014 03:16:56 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	001	0	2015	Clackamas, Marion, Multnomah, Polk, Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3805	007	0	1	01	01	H3805_007_0	4		1	05/30/2014	2015.02	05/30/2014 04:29:49 PM Central Daylight Time	08/04/2014 02:19:37 PM Central Daylight Time	07/31/2014 03:16:59 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H3805	007	0	2015	Benton, Lane, and Linn counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3805	012	0	1	01	01	H3805_012_0	4		1	05/30/2014	2015.02	05/30/2014 04:30:00 PM Central Daylight Time	08/04/2014 02:20:35 PM Central Daylight Time	07/31/2014 03:17:02 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	012	0	2015	Clackamas, Marion, Multnomah, Polk, Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3805	013	0	1	01	01	H3805_013_0	4		1	05/30/2014	2015.02	05/30/2014 04:30:10 PM Central Daylight Time	08/04/2014 02:21:05 PM Central Daylight Time	07/31/2014 03:17:06 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H3805	013	0	2015	Benton, Lane, and Linn counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3805	801	0	1	01	01	H3805_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:13:24 AM Central Daylight Time	05/30/2014 05:33:28 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	801	0	2015	OR Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H3805	803	0	1	01	01	H3805_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:13:34 AM Central Daylight Time	05/30/2014 05:33:50 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	803	0	2015	OR Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H3805	804	0	1	01	01	H3805_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:13:39 AM Central Daylight Time	05/30/2014 05:34:12 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF OREGON, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H3805	804	0	2015	OR Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H3809	001	0	1	20	08	H3809_001_0	2		1	05/30/2014	2015.01	05/30/2014 02:27:31 PM Pacific Daylight Time		05/30/2014 02:25:50 PM Pacific Daylight Time			05/30/2014 02:29:10 PM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (dual) (PACE)	08	20		1			H3809	001	0	2015	Multnomah and Washington Counties		2		2			2								http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/	http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove									(503)215-6556		(503)215-6556		(503)215-6556		(503)215-6556										(503)215-6556		(503)215-6556		(503)215-6556		(503)215-6556												
H3809	002	0	1	20	08	H3809_002_0	2		1	05/30/2014	2015.01	05/30/2014 02:27:48 PM Pacific Daylight Time		05/30/2014 02:25:23 PM Pacific Daylight Time			05/30/2014 02:29:10 PM Pacific Daylight Time	PROVIDENCE HEALTH & SERVICES - OREGON	Providence ElderPlace Portland	www.providence.org/elderplace	Providence ElderPlace Portland (pvt pay) (PACE)	08	20		1			H3809	002	0	2015	Multnomah and Washington Counties		2		2			2								http://oregon.providence.org/our-services/p/providence-elderplace-prescription-medications/	http://oregon.providence.org/our-services/p/providence-long-term-care-pharmacy-for-clinicians-hp/ove									(503)215-6556		(503)215-6556		(503)215-6556		(503)215-6556										(503)215-6556		(503)215-6556		(503)215-6556		(503)215-6556												
H3810	001	0	1	01	01	H3810_001_0	7		1	07/21/2014	2015.01	07/21/2014 04:26:28 PM Pacific Daylight Time	06/02/2014 04:48:58 PM Pacific Daylight Time				07/21/2014 04:32:59 PM Pacific Daylight Time	MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION	CareSource	www.caresourcehealthplan.com	CareSource Gold (HMO)	01	01		1			H3810	001	0	2015	Counties:  JO, JA, DO*		2	390	2			2							www.caresourcehealthplan.com/index.php/directory-providers/	www.caresourcehealthplan.com/index.php/prescription-drug-information/are-my-prescriptions-covered/	http://www.caresourcehealthplan.com/index.php/prescription-drug-information/pharmacy-directory/	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2
H3810	003	0	1	01	01	H3810_003_0	9		1	08/06/2014	2015.01	08/06/2014 11:19:11 AM Pacific Daylight Time	08/06/2014 11:15:07 AM Pacific Daylight Time	08/06/2014 11:14:54 AM Pacific Daylight Time			08/06/2014 11:41:11 AM Pacific Daylight Time	MID ROGUE INDEPENDENT PHYSICIAN ASSOCIATION	CareSource	www.caresourcehealthplan.com	CareSource Gold Plus Rx (HMO)	01	01		1			H3810	003	0	2015	Counties: JO, JA, DO*		2	1219	2			2							www.caresourcehealthplan.com/index.php/directory-providers/	www.caresourcehealthplan.com/index.php/prescription-drug-information/are-my-prescriptions-covered/	http://www.caresourcehealthplan.com/index.php/prescription-drug-information/pharmacy-directory/	(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(888)460-0185		(541)471-4106		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3811	001	0	1	01	01	H3811_001_0	2		1	05/30/2014	2015.01	05/30/2014 01:27:29 PM Pacific Daylight Time	07/18/2014 02:33:02 PM Pacific Daylight Time				07/18/2014 02:34:08 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/SHPlans	Samaritan Advantage Conventional Plan (HMO)	01	01		1			H3811	001	0	2015	Benton, Lincoln and Linn county		2		2			2							www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2
H3811	002	0	1	01	01	H3811_002_0	4		1	08/06/2014	2015.01	08/06/2014 02:22:01 PM Pacific Daylight Time	08/05/2014 04:16:34 PM Pacific Daylight Time	08/04/2014 12:47:28 PM Pacific Daylight Time			08/06/2014 02:37:50 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/SHPlans	Samaritan Advantage Premier Plan (HMO)	01	01		1			H3811	002	0	2015	Benton, Lincoln and Linn county		2		2			2							www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3811	003	0	1	01	01	H3811_003_0	4	2	1	08/06/2014	2015.01	08/06/2014 02:20:24 PM Pacific Daylight Time	08/05/2014 04:22:22 PM Pacific Daylight Time	08/04/2014 12:47:58 PM Pacific Daylight Time			08/06/2014 02:37:50 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/SHPlans	Samaritan Advantage Special Needs Plan (HMO SNP)	01	01		1			H3811	003	0	2015	Benton, Linn and Lincoln county		2		2			1	3		1	3		2	www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3811	009	0	1	01	01	H3811_009_0	4		1	08/06/2014	2015.01	08/06/2014 02:17:12 PM Pacific Daylight Time	08/06/2014 02:28:50 PM Pacific Daylight Time	08/05/2014 09:24:26 PM Pacific Daylight Time			08/06/2014 02:37:50 PM Pacific Daylight Time	SAMARITAN HEALTH PLANS, INC.	Samaritan Advantage Health Plan	www.samhealth.org/SHPlans	Samaritan Advantage Premier Plan Plus (HMO)	01	01		1			H3811	009	0	2015	Benton, Lincoln, and Linn Counties		2		2			2							www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	www.samhealth.org/SHPlans	(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)832-4580		(541)768-4550		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3812	001	0	1	04	01	H3812_001_0	4		1	05/30/2014	2015.02	05/30/2014 04:30:23 PM Central Daylight Time	08/04/2014 02:49:59 PM Central Daylight Time	07/31/2014 03:17:09 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H3812	001	0	2015	Clackamas,Lane,Multnomah,Marion,Washington,Yamhill		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3812	005	0	1	04	01	H3812_005_0	5		1	07/18/2014	2015.02	07/18/2014 09:30:14 AM Central Daylight Time	08/04/2014 05:44:20 PM Central Daylight Time	07/31/2014 03:17:48 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H3812	005	0	2015	Clackamas, Lane, Multnomah and Washington counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3813	001	0	1	04	01	H3813_001_0	5		1	07/15/2014	2015.01	07/15/2014 08:58:25 AM Pacific Daylight Time	07/18/2014 09:03:42 AM Pacific Daylight Time				07/18/2014 09:52:25 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPO (PPO)	01	04		1			H3813	001	0	2015	State of Oregon		2	1000	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-										2					2					
H3813	004	0	1	04	01	H3813_004_0	7		1	07/31/2014	2015.01	07/31/2014 10:38:38 AM Pacific Daylight Time	08/05/2014 09:24:10 AM Pacific Daylight Time	07/31/2014 01:42:40 PM Pacific Daylight Time			08/05/2014 12:03:21 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA Health Plan, Inc.	www.Modahealth.com/salemmedicare	Salem Health Medicare, powered by Moda Health (PPO)	01	04		1			H3813	004	0	2015	Marion and Polk		2	1000	2			2							www.Modahealth.com/salemmedicare	www.Modahealth.com/salemmedicare	www.Modahealth.com/salemmedicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3813	005	0	1	04	01	H3813_005_0	7		1	07/15/2014	2015.01	07/15/2014 09:01:33 AM Pacific Daylight Time	08/05/2014 09:25:34 AM Pacific Daylight Time	07/31/2014 01:43:49 PM Pacific Daylight Time			08/05/2014 12:03:21 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA Health Plan, Inc.	www.Modahealth.com/legacymedicare	Legacy Health Medicare, powered by Moda Health (PPO)	01	04		1			H3813	005	0	2015	Multnomah, Clackamas and Washington Counties		2	1000	2			2							www.Modahealth.com/legacymedicare	www.Modahealth.com/legacymedicare	www.Modahealth.com/legacymedicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3813	006	0	1	04	01	H3813_006_0	8		1	07/15/2014	2015.01	07/15/2014 09:03:04 AM Pacific Daylight Time	08/05/2014 09:27:10 AM Pacific Daylight Time	07/31/2014 01:44:41 PM Pacific Daylight Time			08/05/2014 12:03:21 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX (PPO)	01	04		1			H3813	006	0	2015	State of Oregon		2	1000	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3813	802	0	1	04	01	H3813_802_0	5		1	07/02/2014	2015.01	07/02/2014 01:21:33 PM Pacific Daylight Time	07/18/2014 08:54:57 AM Pacific Daylight Time				07/18/2014 09:00:18 AM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA Health Plan, Inc.	www.modahealth.com/medicare	Moda Health PPORX Employer Option (PPO)	01	04		1			H3813	802	0	2015	State of Oregon		1	7000	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3814	007	0	1	01	01	H3814_007_0	5	2	1	07/17/2014	2015.01	07/17/2014 02:32:42 PM Pacific Daylight Time	08/06/2014 01:10:52 PM Pacific Daylight Time	08/06/2014 01:10:57 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Special Needs Plan (HMO SNP)	01	01		1			H3814	007	0	2015	Douglas and Klamath Counties		2	1881	2			1	3		1	3		2	www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2
H3814	029	0	1	01	01	H3814_029_0	5	2	1	07/17/2014	2015.01	07/17/2014 02:33:08 PM Pacific Daylight Time	08/06/2014 01:11:03 PM Pacific Daylight Time	08/06/2014 01:11:08 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Special Needs Plan (Rogue) (HMO SNP)	01	01		1			H3814	029	0	2015	Josephine County		2	400	2			1	3		1	3		2	www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2
H3815	001	0	1	01	01	H3815_001_0	13		1	09/18/2014	2015.01	09/18/2014 11:56:05 AM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time			09/18/2014 12:22:07 PM Pacific Daylight Time	CITIZENS CHOICE HEALTHPLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Citizens Choice Health Plan (HMO)	01	01		1			H3815	001	0	2015	LA, North OC, SB, RIV		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3815	006	0	1	01	01	H3815_006_0	11		1	09/18/2014	2015.01	09/18/2014 11:59:31 AM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time			09/18/2014 12:45:06 PM Pacific Daylight Time	CITIZENS CHOICE HEALTHPLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Citizens Choice Health Plan (HMO)	01	01		1			H3815	006	0	2015	Stanislaus, San Joaquin		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3815	007	0	1	01	01	H3815_007_0	9		1	09/18/2014	2015.01	09/18/2014 12:01:44 PM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time			09/18/2014 01:01:09 PM Pacific Daylight Time	CITIZENS CHOICE HEALTHPLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Citizens Choice Health Plan (HMO)	01	01		1			H3815	007	0	2015	Santa Clara		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3815	008	0	1	01	01	H3815_008_0	7		1	09/18/2014	2015.01	09/18/2014 12:02:29 PM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time	08/04/2014 11:52:34 AM Pacific Daylight Time			09/18/2014 01:15:41 PM Pacific Daylight Time	CITIZENS CHOICE HEALTHPLAN	Citizens Choice Health Plan	www.citizenschoicehealth.com	Platinum Plan (HMO)	01	01		1			H3815	008	0	2015	LA/Orange		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3815	009	0	1	01	01	H3815_009_0	5		1	08/04/2014	2015.01	08/04/2014 02:35:47 PM Pacific Daylight Time	08/04/2014 02:32:52 PM Pacific Daylight Time	08/04/2014 02:32:42 PM Pacific Daylight Time			08/04/2014 02:37:21 PM Pacific Daylight Time	CITIZENS CHOICE HEALTHPLAN	Citizens Choice Healthplan	www.citizenschoicehealth.com	Citizens Choice Healthplan (CalPlus Plan) (HMO)	01	01		1			H3815	009	0	2015	Riv, SanB, Sta, San Joaquin, Santa Clara, LA, OC		2	1000	2			2							www.citizenschoicehealth.com	http://www.citizenschoicehealth.com/findadrug.aspx	www.citizenschoicehealth.com	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(866)634-2247		(323)728-7232	5550	(866)646-2247		(323)728-7232	5551	(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3817	007	1	1	04	01	H3817_007_1	8		1	07/14/2014	2015.01	07/14/2014 02:29:55 PM Mountain Daylight Time	06/27/2014 02:09:23 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H3817	007	1	2015	Select Counties in Oregon/Clark Co, WA	Metro	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H3817	007	2	1	04	01	H3817_007_2	8		1	07/14/2014	2015.01	07/14/2014 02:29:55 PM Mountain Daylight Time	06/27/2014 02:09:46 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H3817	007	2	2015	Select Counties in Oregon/Clark Co, WA	NonMetro	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H3817	007	3	1	04	01	H3817_007_3	8		1	07/14/2014	2015.01	07/14/2014 02:29:56 PM Mountain Daylight Time	06/27/2014 02:10:09 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H3817	007	3	2015	Select Counties in Oregon/Clark Co, WA	Rural	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H3817	008	1	1	04	01	H3817_008_1	9		1	07/14/2014	2015.01	07/14/2014 02:32:11 PM Mountain Daylight Time	08/05/2014 10:25:56 AM Pacific Daylight Time	08/01/2014 08:26:24 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	1	2015	Select Counties in Oregon/Clark Co, WA	Metro	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3817	008	2	1	04	01	H3817_008_2	9		1	07/14/2014	2015.01	07/14/2014 02:32:17 PM Mountain Daylight Time	08/05/2014 10:26:10 AM Pacific Daylight Time	08/01/2014 08:27:02 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	2	2015	Select Counties in Oregon/Clark Co, WA	NonMetro	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3817	008	3	1	04	01	H3817_008_3	9		1	07/14/2014	2015.01	07/14/2014 02:32:22 PM Mountain Daylight Time	08/05/2014 10:26:22 AM Pacific Daylight Time	08/01/2014 08:27:56 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H3817	008	3	2015	Select Counties in Oregon/Clark Co, WA	Rural	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3817	009	1	1	04	01	H3817_009_1	9		1	07/14/2014	2015.01	07/14/2014 02:32:27 PM Mountain Daylight Time	08/05/2014 10:26:34 AM Pacific Daylight Time	08/01/2014 08:28:20 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	1	2015	Select Counties in Oregon/Clark Co, WA	Metro	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3817	009	2	1	04	01	H3817_009_2	9		1	07/14/2014	2015.01	07/14/2014 02:32:32 PM Mountain Daylight Time	08/05/2014 10:26:48 AM Pacific Daylight Time	08/01/2014 08:28:48 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	2	2015	Select Counties in Oregon/Clark Co, WA	NonMetro	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3817	009	3	1	04	01	H3817_009_3	9		1	07/14/2014	2015.01	07/14/2014 02:32:38 PM Mountain Daylight Time	08/05/2014 10:27:00 AM Pacific Daylight Time	08/01/2014 08:29:08 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H3817	009	3	2015	Select Counties in Oregon/Clark Co, WA	Rural	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3817	801	0	1	04	01	H3817_801_0	8		1	07/09/2014	2015.01	07/09/2014 05:34:54 PM Mountain Daylight Time	06/30/2014 06:38:52 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H3817	801	0	2015	Nationwide except territories		1	2086	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										2					2					
H3817	802	0	1	04	01	H3817_802_0	8		1	07/09/2014	2015.01	07/09/2014 05:35:06 PM Mountain Daylight Time	06/30/2014 06:39:22 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H3817	802	0	2015	Nationwide except territories		1	2047	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3818	002	0	1	01	01	H3818_002_0	13	2	1	09/10/2014	2015.01	09/10/2014 11:30:48 AM Pacific Daylight Time	08/04/2014 10:22:31 AM Pacific Daylight Time	08/01/2014 09:44:55 AM Pacific Daylight Time			09/22/2014 12:01:50 PM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycarehealthplans.org	FamilyCare Community (HMO SNP)	01	01		1			H3818	002	0	2015	Portland Metro Clatsop Morrow Umatilla Counties		2	2017	2			1	3		1	3		1	www.familycarehealthplans.org	www.familycarehealthplans.org	www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3818	003	0	1	01	01	H3818_003_0	10		1	07/14/2014	2015.01	07/14/2014 03:45:51 PM Pacific Daylight Time	08/04/2014 10:23:39 AM Pacific Daylight Time	08/01/2014 09:45:09 AM Pacific Daylight Time			08/06/2014 08:35:55 AM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycarehealthplans.org	FamilyCare Advantage Rx (HMO)	01	01		1			H3818	003	0	2015	Portland Metro Clatsop Morrow Umatilla Counties		2	496	2			2							www.familycarehealthplans.org	www.familycarehealthplans.org	www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					1					2
H3818	004	0	1	01	01	H3818_004_0	9		1	07/23/2014	2015.01	07/23/2014 10:35:23 AM Pacific Daylight Time	06/04/2014 02:27:57 PM Pacific Daylight Time				07/23/2014 10:43:45 AM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	www.familycarehealthplans.org	FamilyCare Select (HMO)	01	01		1			H3818	004	0	2015	Portland Metro Clatsop Morrow Umatilla Counties		2	84	2			2							www.familycarehealthplans.org	http://www.familycarehealthplans.org	http://www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2
H3818	014	0	1	01	01	H3818_014_0	11		1	07/23/2014	2015.01	07/23/2014 10:35:53 AM Pacific Daylight Time	08/04/2014 10:24:32 AM Pacific Daylight Time	08/01/2014 09:45:23 AM Pacific Daylight Time			08/06/2014 08:46:50 AM Pacific Daylight Time	FAMILYCARE HEALTH PLANS, INC.	FamilyCare Health Plans, Inc.	familycarehealthplans.org	FamilyCare Select Rx (HMO)	01	01		1			H3818	014	0	2015	Portland Metro Clatsop Morrow Umatilla Counties		2	48	2			2							www.familycarehealthplans.org	www.familycarehealthplans.org	www.familycarehealthplans.org	(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(866)798-2273		(503)345-5702		(866)225-2273		(503)345-5701		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3822	001	0	1	01	01	H3822_001_0	13		1	08/06/2014	2015.01	08/06/2014 09:00:41 AM Central Daylight Time	08/05/2014 04:16:00 PM Central Daylight Time	08/05/2014 09:31:20 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	001	0	2015	Cook, DuPage, Will and Kane counties		2	6011	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	002	0	1	01	01	H3822_002_0	16		1	08/06/2014	2015.01	08/06/2014 08:46:23 AM Central Daylight Time	08/05/2014 04:19:04 PM Central Daylight Time	08/05/2014 09:33:42 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3822	002	0	2015	Bernalillo, Sandoval, Torrence and Valencia cntys		2	4801	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	003	0	1	01	01	H3822_003_0	11		1	08/06/2014	2015.01	08/06/2014 08:47:48 AM Central Daylight Time	08/05/2014 04:20:46 PM Central Daylight Time	08/05/2014 09:35:20 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	Blue Cross Medicare Advantage Premier (HMO)	01	01		1			H3822	003	0	2015	Bernalillo, Sandoval, Torrence, Valencia cnty		2	404	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	005	0	1	02	01	H3822_005_0	10		1	08/06/2014	2015.01	08/06/2014 08:48:26 AM Central Daylight Time	08/05/2014 04:23:16 PM Central Daylight Time	08/05/2014 09:37:54 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3822	005	0	2015	Bernalillo, Sandoval, Torrance, Valencia counties		2	107	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	006	0	1	01	01	H3822_006_0	8	2	1	07/24/2014	2015.01	07/24/2014 12:16:14 PM Central Daylight Time	08/05/2014 03:54:48 PM Central Daylight Time	08/05/2014 09:39:42 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluedual.com	Blue Cross Medicare Advantage Dual Care (HMO SNP)	01	01		1			H3822	006	0	2015	Bernalillo, Sandoval, Torrance and Valencia		2	1001	2			1	3		1	4			www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	007	0	1	02	01	H3822_007_0	10		1	08/06/2014	2015.01	08/06/2014 08:49:28 AM Central Daylight Time	08/05/2014 04:24:34 PM Central Daylight Time	08/05/2014 09:43:08 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	Blue Cross Medicare Advantage Basic Plus (HMO-POS)	01	02		1			H3822	007	0	2015	Cook, DuPage, Kane and Will counties		2	3028	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	008	0	1	02	01	H3822_008_0	11		1	08/06/2014	2015.01	08/06/2014 08:50:03 AM Central Daylight Time	08/05/2014 04:25:40 PM Central Daylight Time	08/05/2014 09:44:48 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3822	008	0	2015	Cook, DuPage, Kane and Will counties		2	1147	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3822	801	0	1	01	01	H3822_801_0	3		1	06/02/2014	2015.01	06/02/2014 08:42:43 AM Central Daylight Time	07/23/2014 02:11:44 PM Central Daylight Time				07/23/2014 02:43:01 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	801	0	2015	State of Illinois		1	5663	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H3822	802	0	1	01	01	H3822_802_0	2		1	06/02/2014	2015.01	06/02/2014 08:46:15 AM Central Daylight Time	07/22/2014 02:43:28 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	802	0	2015	State of New Mexico		1	298	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H3822	805	0	1	01	01	H3822_805_0	3		1	06/02/2014	2015.01	06/02/2014 08:52:15 AM Central Daylight Time	07/23/2014 02:13:32 PM Central Daylight Time				07/23/2014 02:43:01 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	805	0	2015	State of Illinois		1	5663	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H3822	806	0	1	01	01	H3822_806_0	2		1	06/02/2014	2015.01	06/02/2014 08:48:57 AM Central Daylight Time	07/22/2014 02:45:02 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	806	0	2015	State of New Mexico		1	298	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H3822	809	0	1	01	01	H3822_809_0	3		1	06/02/2014	2015.01	06/02/2014 08:45:37 AM Central Daylight Time	07/23/2014 02:15:06 PM Central Daylight Time				07/23/2014 02:43:01 PM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	809	0	2015	State of Illinois		1	5663	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001100000001100000000	2		1					1
H3822	810	0	1	01	01	H3822_810_0	2		1	05/24/2014	2015.01	05/24/2014 11:37:16 AM Central Daylight Time	06/02/2014 09:09:58 AM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross Blue Shield of IL, NM	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3822	810	0	2015	State of New Mexico		1	100	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001100000001100000000	2		1					1
H3832	007	0	1	04	01	H3832_007_0	10		1	07/23/2014	2015.01	07/23/2014 11:23:18 AM Hawaiian Standard Time	08/04/2014 06:03:50 AM Hawaiian Standard Time	08/04/2014 05:52:10 AM Hawaiian Standard Time			08/06/2014 10:17:30 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Standard (PPO)	01	04		1			H3832	007	0	2015	Hawaii, Kalawao, Kauai and Maui counties		2	775	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3832	008	0	1	04	01	H3832_008_0	8		1	07/25/2014	2015.01	07/25/2014 01:01:11 PM Hawaiian Standard Time	08/04/2014 06:04:28 AM Hawaiian Standard Time	08/04/2014 05:52:33 AM Hawaiian Standard Time			08/06/2014 10:35:25 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Standard Plus (PPO)	01	04		1			H3832	008	0	2015	Hawaii, Kalawao, Kauai and Maui counties		2	18542	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3832	009	0	1	04	01	H3832_009_0	9		1	07/23/2014	2015.01	07/23/2014 01:42:04 PM Hawaiian Standard Time	08/04/2014 06:05:03 AM Hawaiian Standard Time	08/04/2014 05:52:51 AM Hawaiian Standard Time			08/06/2014 10:41:15 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Complete (PPO)	01	04		1			H3832	009	0	2015	Honolulu County		2	1766	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3832	010	0	1	04	01	H3832_010_0	7		1	07/23/2014	2015.01	07/23/2014 11:24:43 AM Hawaiian Standard Time	08/04/2014 06:05:31 AM Hawaiian Standard Time	08/04/2014 05:53:11 AM Hawaiian Standard Time			08/06/2014 10:48:58 AM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Complete Plus (PPO)	01	04		1			H3832	010	0	2015	County of Honolulu		2	8910	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3832	801	0	1	04	01	H3832_801_0	3		1	06/02/2014	2015.01	06/02/2014 05:53:38 PM Hawaiian Standard Time	06/01/2014 05:17:41 PM Hawaiian Standard Time				06/02/2014 06:26:15 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage EGWP with Drug CY (PPO)	01	04		1			H3832	801	0	2015	National		1	2000	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010011100010000011110110001100000100	2		1					
H3832	802	0	1	04	01	H3832_802_0	3		1	06/02/2014	2015.01	06/02/2014 05:53:43 PM Hawaiian Standard Time	06/01/2014 05:18:35 PM Hawaiian Standard Time				06/02/2014 06:28:35 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage EGWP with Drug NCY (PPO)	01	04		1			H3832	802	0	2015	National		1	100	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)620-4672		(808)948-5555		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010011100010000011110110001100000100	2		1					
H3832	805	0	1	04	01	H3832_805_0	3		1	06/02/2014	2015.01	06/02/2014 05:54:04 PM Hawaiian Standard Time	06/01/2014 05:19:30 PM Hawaiian Standard Time				06/02/2014 06:31:58 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage EGWP CY (PPO)	01	04		1			H3832	805	0	2015	National		1	2000	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-										1	1	010011100010000011110110001100000100	2		1					
H3832	807	0	1	04	01	H3832_807_0	3		1	06/02/2014	2015.01	06/02/2014 05:54:10 PM Hawaiian Standard Time	06/01/2014 05:21:16 PM Hawaiian Standard Time				06/02/2014 06:34:05 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION	Akamai Advantage by HMSA	www.hmsa.com/advantage	Akamai Advantage Union Group Plan MAPD (PPO)	01	04		1			H3832	807	0	2015	National		1	5000	2			2							www.hmsa.com/advantage	www.hmsa.com/advantage	www.hmsa.com/advantage	(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	010011100010000011110110001100000100	2		1					
H3864	002	0	1	01	01	H3864_002_0	8		1	07/16/2014	2015.01	07/16/2014 11:03:04 AM Pacific Daylight Time	07/15/2014 04:39:48 PM Pacific Daylight Time				07/17/2014 03:30:10 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 2 (HMO)	01	01		1			H3864	002	0	2015	Central, Eastern Oregon and Mid-Columbia Gorge		2	1971	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					2
H3864	006	0	1	01	01	H3864_006_0	7		1	07/09/2014	2015.01	07/09/2014 12:31:18 PM Pacific Daylight Time	08/01/2014 02:36:10 PM Pacific Daylight Time	08/04/2014 08:56:39 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 6 (HMO)	01	01		1			H3864	006	0	2015	Central, Eastern Oregon and Mid-Columbia Gorge		2	3097	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	014	0	1	01	01	H3864_014_0	7		1	07/09/2014	2015.01	07/09/2014 12:31:40 PM Pacific Daylight Time	08/01/2014 02:48:52 PM Pacific Daylight Time	08/04/2014 08:56:39 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 14 (HMO)	01	01		1			H3864	014	0	2015	Central, Eastern Oregon and Mid-Columbia Gorge		2	4547	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	015	0	1	01	01	H3864_015_0	7		1	07/09/2014	2015.01	07/09/2014 12:31:56 PM Pacific Daylight Time	08/01/2014 02:59:46 PM Pacific Daylight Time	08/04/2014 08:56:39 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 15 (HMO)	01	01		1			H3864	015	0	2015	Lane County		2	2400	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	016	0	1	01	01	H3864_016_0	7		1	07/09/2014	2015.01	07/09/2014 12:32:14 PM Pacific Daylight Time	08/01/2014 03:12:44 PM Pacific Daylight Time	08/04/2014 08:56:39 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 16 (HMO)	01	01		1			H3864	016	0	2015	Southwestern Idaho		2	1704	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	019	0	1	01	01	H3864_019_0	9		1	07/09/2014	2015.01	07/09/2014 12:32:29 PM Pacific Daylight Time	08/01/2014 03:52:53 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 19 (HMO)	01	01		1			H3864	019	0	2015	Southwestern Oregon		2	190	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	020	0	1	01	01	H3864_020_0	7		1	07/09/2014	2015.01	07/09/2014 12:32:52 PM Pacific Daylight Time	08/01/2014 03:57:08 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 20 (HMO)	01	01		1			H3864	020	0	2015	Northern Idaho		2	1007	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	021	0	1	01	01	H3864_021_0	7		1	07/09/2014	2015.01	07/09/2014 12:33:11 PM Pacific Daylight Time	08/01/2014 04:04:11 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 21 (HMO)	01	01		1			H3864	021	0	2015	Eastern Idaho		2	470	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	022	0	1	01	01	H3864_022_0	6		1	07/15/2014	2015.01	07/15/2014 03:03:33 PM Pacific Daylight Time	08/01/2014 04:08:39 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 22 (HMO)	01	01		1			H3864	022	0	2015	Clackamas, Multnomah, and Washington Counties		2	500	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	023	0	1	01	01	H3864_023_0	8		1	07/15/2014	2015.01	07/15/2014 03:04:19 PM Pacific Daylight Time	08/01/2014 04:16:58 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare MyCare Rx 23 (HMO)	01	01		1			H3864	023	0	2015	Southwestern Idaho		2	400	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	024	0	1	02	01	H3864_024_0	10		1	07/10/2014	2015.01	07/10/2014 12:53:47 PM Pacific Daylight Time	08/01/2014 04:27:37 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 24 (HMO-POS)	01	02		1			H3864	024	0	2015	Southwestern Idaho		2	550	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	025	0	1	02	01	H3864_025_0	7		1	07/09/2014	2015.01	07/09/2014 12:34:16 PM Pacific Daylight Time	08/04/2014 03:44:31 PM Pacific Daylight Time	08/04/2014 08:56:40 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Choice Rx 25 (HMO-POS)	01	02		1			H3864	025	0	2015	Central, Eastern Oregon and Mid-Columbia Gorge		2	250	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H3864	801	0	1	01	01	H3864_801_0	7		1	06/02/2014	2015.01	06/02/2014 04:01:30 PM Pacific Daylight Time	06/12/2014 10:44:52 AM Pacific Daylight Time				06/12/2014 10:50:26 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials 801 (HMO)	01	01		1			H3864	801	0	2015	Statewide - Oregon and Idaho		1	1417	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	011100011011001011111110011100000100	2		1					1
H3864	803	0	1	01	01	H3864_803_0	5		1	06/02/2014	2015.01	06/02/2014 10:51:30 AM Pacific Daylight Time	06/04/2014 09:48:42 AM Pacific Daylight Time				06/04/2014 11:39:17 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Essentials Rx 803 (HMO)	01	01		1			H3864	803	0	2015	Statewide - Oregon and Idaho		1	100	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	011100011011001011111110011100000100	2		1					1
H3887	001	0	1	02	01	H3887_001_0	5		1	08/04/2014	2015.02	08/04/2014 05:52:30 PM Central Daylight Time	08/12/2014 09:47:20 AM Central Daylight Time	07/31/2014 03:17:52 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H3887	001	0	2015	Cook, Du Page, Kane and Lake counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3887	003	0	1	02	01	H3887_003_0	2		1	06/26/2014	2015.02	06/26/2014 03:44:09 PM Central Daylight Time	08/04/2014 02:54:05 PM Central Daylight Time	07/31/2014 03:17:55 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus (HMO-POS)	01	02		1			H3887	003	0	2015	Cook, Kane and Will counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3907	002	0	1	01	01	H3907_002_0	5		1	05/23/2014	2015.01	05/23/2014 03:16:12 PM Eastern Daylight Time	06/02/2014 05:28:56 PM Eastern Daylight Time				06/02/2014 07:36:25 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life (HMO)	01	01		1			H3907	002	0	2015	Western Pennsylvania		2	18000	2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										2					2					2
H3907	006	0	1	01	01	H3907_006_0	8		1	05/30/2014	2015.01	05/30/2014 01:50:54 PM Eastern Daylight Time	08/06/2014 11:05:40 PM Eastern Daylight Time	08/06/2014 11:06:04 PM Eastern Daylight Time			08/06/2014 11:11:00 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life HMO Rx Enhanced (HMO)	01	01		1			H3907	006	0	2015	Western Pennsylvania		2	7000	2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2
H3907	029	0	1	01	01	H3907_029_0	7		1	05/30/2014	2015.01	05/30/2014 01:58:40 PM Eastern Daylight Time	08/06/2014 10:30:07 AM Eastern Daylight Time	07/31/2014 04:45:01 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life HMO Rx (HMO)	01	01		1			H3907	029	0	2015	Western Pennsylvania		2	40000	2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2
H3907	032	0	1	01	01	H3907_032_0	6		1	08/06/2014	2015.01	08/06/2014 06:59:34 AM Eastern Daylight Time	08/06/2014 12:54:50 PM Eastern Daylight Time	07/31/2014 04:45:13 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	www.upmchealthplan.com/snp	UPMC for Life Options (HMO SNP)	01	01		1			H3907	032	0	2015	Select PA Counties		2	250	2			1	1	3	1				www.upmchealthplan.com/snp	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		2					2					2
H3907	037	0	1	01	01	H3907_037_0	7		1	05/28/2014	2015.01	05/28/2014 03:30:43 PM Eastern Daylight Time	08/06/2014 10:31:59 AM Eastern Daylight Time	08/11/2014 01:07:23 PM Eastern Daylight Time			08/11/2014 01:08:45 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	037	0	2015	Western Pennsylvania		2	2000	2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2
H3907	038	0	1	01	01	H3907_038_0	4		1	05/22/2014	2015.01	05/22/2014 10:52:02 AM Eastern Daylight Time	06/02/2014 05:36:08 PM Eastern Daylight Time				06/02/2014 07:36:25 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life HMO (HMO)	01	01		1			H3907	038	0	2015	Lancaster County		2	50	2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										2					2					2
H3907	039	0	1	01	01	H3907_039_0	6		1	05/28/2014	2015.01	05/28/2014 03:31:36 PM Eastern Daylight Time	08/06/2014 10:32:56 AM Eastern Daylight Time	07/31/2014 04:45:30 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life HMO Deductible with Rx (HMO)	01	01		1			H3907	039	0	2015	Lancaster County		2	150	2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					2
H3907	801	0	1	01	01	H3907_801_0	4		1	05/16/2014	2015.01	05/16/2014 03:43:44 PM Eastern Daylight Time	06/02/2014 05:38:24 PM Eastern Daylight Time				06/02/2014 07:36:25 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (HMO)	01	01		1			H3907	801	0	2015	Western Pennsylvania		1		2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										1	1	011100011000000000100110001000000100	2		1					1
H3907	802	0	1	01	01	H3907_802_0	4		1	05/22/2014	2015.01	05/22/2014 10:45:10 AM Eastern Daylight Time	06/02/2014 05:40:02 PM Eastern Daylight Time				06/02/2014 07:36:25 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (HMO)	01	01		1			H3907	802	0	2015	Western Pennsylvania		1		2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	011100011000000000100110001000000100	2		1					1
H3907	803	0	1	01	01	H3907_803_0	4		1	05/16/2014	2015.01	05/16/2014 01:44:19 PM Eastern Daylight Time	06/02/2014 05:41:10 PM Eastern Daylight Time				06/02/2014 07:36:25 PM Eastern Daylight Time	UPMC HEALTH PLAN, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (HMO)	01	01		1			H3907	803	0	2015	Western Pennsylvania		1		2			2							http://www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	011100011000000000100110001000000100	2		1					1
H3908	001	0	1	20	08	H3908_001_0	1		1	05/28/2014	2015.01	05/28/2014 11:06:23 AM Eastern Daylight Time		05/20/2014 05:46:19 PM Eastern Daylight Time			05/28/2014 11:09:30 AM Eastern Daylight Time	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA	Trustees Of The University Of Pennsylvania	http://www.lifeupenn.org/	Trustees of the University of Pennsylvania (PACE)	08	20		1			H3908	001	0	2015	Philadelphia, PA		2		2			2								www.LIFEUPENN.org	www.CareKinesis.com									(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200										(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200												
H3908	002	0	1	20	08	H3908_002_0	1		1	05/28/2014	2015.01	05/28/2014 11:07:16 AM Eastern Daylight Time		05/20/2014 05:56:30 PM Eastern Daylight Time			05/28/2014 11:09:30 AM Eastern Daylight Time	TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA	Trustees Of The University Of Pennsylvania	http://www.lifeupenn.org/	Trustees of the University of Pennsylvania (PACE)	08	20		1			H3908	002	0	2015	Philadelphia, PA		2		2			2								www.LIFEUPENN.org	www.CareKinesis.com									(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200										(215)573-7200		(215)573-7200		(215)573-7200		(215)573-7200												
H3909	001	0	1	04	01	H3909_001_0	5		1	05/28/2014	2015.01	05/28/2014 09:16:03 AM Eastern Daylight Time	08/05/2014 02:52:31 PM Eastern Daylight Time	08/04/2014 01:12:04 PM Eastern Daylight Time			08/06/2014 08:19:19 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	001	0	2015	Bucks, Philadelphia Counties		2	1000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3909	007	0	1	04	01	H3909_007_0	2		1	05/28/2014	2015.01	05/28/2014 09:04:34 AM Eastern Daylight Time	05/31/2014 06:51:10 PM Eastern Daylight Time				06/01/2014 01:12:20 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Medical Only (PPO)	01	04		1			H3909	007	0	2015	Bucks, Philadelphia Counties		2	600	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					
H3909	009	0	1	04	01	H3909_009_0	4		1	05/28/2014	2015.01	05/28/2014 09:06:15 AM Eastern Daylight Time	08/05/2014 02:54:33 PM Eastern Daylight Time	08/04/2014 01:12:04 PM Eastern Daylight Time			08/06/2014 08:19:19 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Rx (PPO)	01	04		1			H3909	009	0	2015	Chester, Delaware, Montgomery Counties		2	1000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3909	801	0	1	04	01	H3909_801_0	3		1	05/29/2014	2015.01	05/29/2014 07:53:19 AM Eastern Daylight Time	06/26/2014 02:26:31 PM Eastern Daylight Time				07/07/2014 08:58:52 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Medical Only (PPO)	01	04		1			H3909	801	0	2015	National		1	1000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										1	1	011100011000000000111110011110000100	2		1					
H3909	802	0	1	04	01	H3909_802_0	6		1	05/29/2014	2015.01	05/29/2014 07:53:55 AM Eastern Daylight Time	06/26/2014 02:27:44 PM Eastern Daylight Time				07/07/2014 08:58:52 AM Eastern Daylight Time	QCC INSURANCE COMPANY	Personal Choice 65 PPO	www.ibxmedicare.com	Personal Choice 65 Group Rx (PPO)	01	04		1			H3909	802	0	2015	National		1	3000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(888)718-3333		(888)718-3333		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011000000000111110011110000100	2		1					
H3912	001	0	1	04	01	H3912_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:31:08 AM Central Daylight Time	08/04/2014 05:45:34 PM Central Daylight Time	07/31/2014 03:17:59 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H3912	001	0	2015	Select Counties in Pennsylvania		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3916	001	0	1	04	01	H3916_001_0	9		1	07/17/2014	2015.01	07/17/2014 02:32:42 PM Eastern Daylight Time	08/01/2014 09:17:41 AM Eastern Daylight Time	08/01/2014 10:37:04 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	001	0	2015	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	002	0	1	04	01	H3916_002_0	9		1	07/17/2014	2015.01	07/17/2014 04:35:35 PM Eastern Daylight Time	08/01/2014 09:17:51 AM Eastern Daylight Time	08/01/2014 10:39:58 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Classic (PPO)	01	04		1			H3916	002	0	2015	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	005	0	1	04	01	H3916_005_0	9		1	07/17/2014	2015.01	07/17/2014 02:32:59 PM Eastern Daylight Time	08/01/2014 09:18:02 AM Eastern Daylight Time	08/01/2014 10:41:49 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Deluxe (PPO)	01	04		1			H3916	005	0	2015	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	012	0	1	04	01	H3916_012_0	8		1	07/17/2014	2015.01	07/17/2014 02:44:23 PM Eastern Daylight Time	07/03/2014 07:57:09 AM Eastern Daylight Time				07/17/2014 05:11:30 PM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Value (PPO)	01	04		1			H3916	012	0	2015	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(800)227-8210		(800)227-8210										2					2					
H3916	015	0	1	04	01	H3916_015_0	10		1	07/17/2014	2015.01	07/17/2014 02:45:40 PM Eastern Daylight Time	08/01/2014 09:18:13 AM Eastern Daylight Time	08/01/2014 10:43:20 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Standard (PPO)	01	04		1			H3916	015	0	2015	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	018	0	1	04	01	H3916_018_0	10		1	07/17/2014	2015.01	07/17/2014 04:32:43 PM Eastern Daylight Time	08/01/2014 09:18:23 AM Eastern Daylight Time	08/01/2014 10:44:40 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	018	0	2015	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	022	0	1	04	01	H3916_022_0	9		1	07/17/2014	2015.01	07/17/2014 02:49:26 PM Eastern Daylight Time	08/01/2014 09:18:34 AM Eastern Daylight Time	08/01/2014 10:47:47 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Select (PPO)	01	04		1			H3916	022	0	2015	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	024	0	1	04	01	H3916_024_0	9		1	07/17/2014	2015.01	07/17/2014 04:36:35 PM Eastern Daylight Time	08/01/2014 09:18:45 AM Eastern Daylight Time	08/01/2014 10:48:57 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO Select (PPO)	01	04		1			H3916	024	0	2015	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	025	0	1	04	01	H3916_025_0	14		1	08/12/2014	2015.01	08/12/2014 12:03:30 PM Eastern Daylight Time	08/01/2014 09:18:55 AM Eastern Daylight Time	08/01/2014 10:50:25 AM Eastern Daylight Time			08/12/2014 12:04:48 PM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO HD Rx (PPO)	01	04		1			H3916	025	0	2015	Central and Northeastern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	032	0	1	04	01	H3916_032_0	10		1	07/17/2014	2015.01	07/17/2014 02:51:32 PM Eastern Daylight Time	08/01/2014 09:19:06 AM Eastern Daylight Time	08/01/2014 10:51:34 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	032	0	2015	Southwestern PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	033	0	1	04	01	H3916_033_0	9		1	07/17/2014	2015.01	07/17/2014 04:37:32 PM Eastern Daylight Time	08/01/2014 09:19:17 AM Eastern Daylight Time	08/01/2014 10:52:43 AM Eastern Daylight Time			08/05/2014 10:13:05 AM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H3916	033	0	2015	West Central PA		2		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H3916	801	0	1	04	01	H3916_801_0	7		1	05/29/2014	2015.01	05/29/2014 09:51:06 AM Eastern Daylight Time	07/03/2014 08:33:12 AM Eastern Daylight Time				07/11/2014 04:35:36 PM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO MA Pennsylvania (PPO)	01	04		1			H3916	801	0	2015	Pennsylvania		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	011111111110100111111111001110000110	2		1					
H3916	802	0	1	04	01	H3916_802_0	7		1	05/29/2014	2015.01	05/29/2014 09:52:33 AM Eastern Daylight Time	07/03/2014 08:33:42 AM Eastern Daylight Time				07/11/2014 04:35:36 PM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO MA-PD Pennsylvania (PPO)	01	04		1			H3916	802	0	2015	Pennsylvania		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					
H3916	804	0	1	04	01	H3916_804_0	7		1	05/29/2014	2015.01	05/29/2014 09:53:03 AM Eastern Daylight Time	07/03/2014 08:34:17 AM Eastern Daylight Time				07/11/2014 04:35:36 PM Eastern Daylight Time	HIGHMARK, INC.	Highmark Inc.	www.highmarkblueshield.com/medicare	Freedom Blue PPO MA-PD PA Non-Calendar (PPO)	01	04		1			H3916	804	0	2015	Pennsylvania		1		2			2							www.highmarkblueshield.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	www.highmarkblueshield.com/medicare	(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(800)550-8722		(800)550-8722		(866)743-5478		(866)743-5478		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					
H3917	001	0	1	20	08	H3917_001_0	1		1	05/29/2014	2015.01	05/29/2014 05:49:39 PM Eastern Daylight Time		05/29/2014 04:23:59 PM Eastern Daylight Time			05/30/2014 09:30:55 AM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Pittsburgh Care Partnership, Inc. (PACE)	08	20		1			H3917	001	0	2015	Allegheny, Westmoreland Counties (Partial of each)		2		2			2								www.commlife.org	www.commlife.org									(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101												
H3917	002	0	1	20	08	H3917_002_0	1		1	05/29/2014	2015.01	05/29/2014 05:32:31 PM Eastern Daylight Time		05/29/2014 04:30:40 PM Eastern Daylight Time			05/30/2014 09:30:55 AM Eastern Daylight Time	PITTSBURGH CARE PARTNERSHIP, INC.	Community LIFE	http://www.commlife.org/	Pittsburgh Care Partnership, Inc. (PACE)	08	20		1			H3917	002	0	2015	Allegheny, Westmoreland Counties (Partial of each)		2		2			2								www.commlife.org	www.commlife.org									(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101										(866)419-1693		(412)464-2101		(866)419-1693		(412)464-2101												
H3918	001	0	1	20	08	H3918_001_0	1		1	05/21/2014	2015.01	05/21/2014 02:13:00 PM Eastern Daylight Time		05/16/2014 03:27:36 PM Eastern Daylight Time			05/21/2014 02:20:41 PM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Dual Eligibles Pharmacy (PACE)	08	20		1			H3918	001	0	2015	Partial Allegheny*		2		2			2								not applicable -- no formulary	none									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228											
H3918	002	0	1	20	08	H3918_002_0	1		1	05/21/2014	2015.01	05/21/2014 02:13:21 PM Eastern Daylight Time		05/16/2014 03:39:53 PM Eastern Daylight Time			05/21/2014 02:20:41 PM Eastern Daylight Time	LIVING INDEPENDENCE FOR THE ELDERLY	LIFE Pittsburgh	LIFEPittsburgh.org	LIFE Pittsburgh Medicare Only Pharmacy (PACE)	08	20		1			H3918	002	0	2015	Allegheny *		2		2			2								not applicable -- no formulary	none									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228									(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228	(412)388-8042	4228											
H3919	001	0	1	20	08	H3919_001_0	1		1	05/19/2014	2015.01	05/19/2014 12:18:42 PM Eastern Daylight Time		05/16/2014 12:56:01 PM Eastern Daylight Time			05/19/2014 12:21:19 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	08	20		1			H3919	001	0	2015	Philadelphia		2		2			2								www.mercylife.org	www.mercylife.org									(855)884-1037		(215)339-4747		(855)884-1037		(215)339-4747										(800)820-4512	4747	(215)339-4747		(800)820-4512	4747	(215)339-4747												
H3919	002	0	1	20	08	H3919_002_0	1		1	05/19/2014	2015.01	05/19/2014 12:18:22 PM Eastern Daylight Time		05/16/2014 01:10:07 PM Eastern Daylight Time			05/19/2014 12:21:19 PM Eastern Daylight Time	ST. AGNES CONTINUING CARE CENTER	Mercy LIFE	www.mercylife.org	Mercy LIFE (PACE)	08	20		1			H3919	002	0	2015	Philadelphia		2		2			2								www.mercylife.org	www.mercylife.org									(855)884-1037		(215)339-4747		(800)820-4512	4747	(215)339-4747										(800)820-4512	4747	(215)339-4747		(800)820-4512	4747	(215)339-4747												
H3921	001	0	1	04	01	H3921_001_0	2		1	05/30/2014	2015.01	05/30/2014 04:34:53 PM Central Daylight Time	08/04/2014 02:22:07 PM Central Daylight Time	07/31/2014 03:18:02 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (PPO)	01	04		1			H3921	001	0	2015	Lancaster and York Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3921	008	0	1	04	01	H3921_008_0	2		1	05/30/2014	2015.01	05/30/2014 04:36:09 PM Central Daylight Time	08/04/2014 02:22:38 PM Central Daylight Time	07/31/2014 03:18:06 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H3921	008	0	2015	Erie, Lehigh and Northampton Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3921	009	0	1	04	01	H3921_009_0	2		1	05/30/2014	2015.01	05/30/2014 04:36:25 PM Central Daylight Time	08/04/2014 02:23:22 PM Central Daylight Time	07/31/2014 03:18:09 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (PPO)	01	04		1			H3921	009	0	2015	Erie, Lehigh and Northampton Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3923	013	0	1	04	01	H3923_013_0	6		1	07/20/2014	2015.01	07/20/2014 11:28:37 AM Eastern Daylight Time	06/01/2014 09:18:44 PM Eastern Daylight Time	05/31/2014 04:27:34 PM Eastern Daylight Time			07/20/2014 11:33:54 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	seniorblueppo.capbluecross.com	SeniorBlue - Option 2 (PPO)	01	04		1			H3923	013	0	2015	21 Counties in Central PA		2	9519	2			2							seniorblueppo.capbluecross.com	https://seniorblueppo.capbluecross.com/PharmacyInformation/	https://seniorblueppo.capbluecross.com/PharmacyInformation/	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		2					2					
H3923	017	0	1	04	01	H3923_017_0	6		1	07/18/2014	2015.01	07/18/2014 01:53:29 PM Eastern Daylight Time	06/01/2014 09:16:15 PM Eastern Daylight Time	05/31/2014 04:29:20 PM Eastern Daylight Time			07/20/2014 11:33:54 AM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	seniorblueppo.capbluecross.com	SeniorBlue - Option 1 (PPO)	01	04		1			H3923	017	0	2015	21 Counties in Central PA		2	5591	2			2							seniorblueppo.capbluecross.com	https://seniorblueppo.capbluecross.com/PharmacyInformation/	https://seniorblueppo.capbluecross.com/PharmacyInformation/	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		2					2					
H3923	801	0	1	04	01	H3923_801_0	4		1	06/02/2014	2015.01	06/02/2014 07:02:00 PM Eastern Daylight Time	06/02/2014 06:59:51 PM Eastern Daylight Time				06/02/2014 08:32:46 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	seniorblueppo.capbluecross.com	MA - ER with Rx (PPO)	01	04		1			H3923	801	0	2015	National		1	1790	2			2							seniorblueppo.capbluecross.com	https://seniorblueppo.capbluecross.com/PharmacyInformation/	https://seniorblueppo.capbluecross.com/PharmacyInformation/	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		1	1	011111111111111111111111111111011011	2		1					
H3923	802	0	1	04	01	H3923_802_0	4		1	06/02/2014	2015.01	06/02/2014 08:13:08 PM Eastern Daylight Time	06/02/2014 07:03:13 PM Eastern Daylight Time				06/02/2014 08:32:46 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	seniorblueppo.capbluecross.com	MA - ER w/o Rx (PPO)	01	04		1			H3923	802	0	2015	National		1	75	2			2							seniorblueppo.capbluecross.com	https://seniorblueppo.capbluecross.com/PharmacyInformation/	https://seniorblueppo.capbluecross.com/PharmacyInformation/	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201										(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961										1	1	011111111111111111111111111111011011	2		1					
H3923	803	0	1	04	01	H3923_803_0	4		1	06/02/2014	2015.01	06/02/2014 08:13:58 PM Eastern Daylight Time	06/02/2014 07:05:22 PM Eastern Daylight Time				06/02/2014 08:32:46 PM Eastern Daylight Time	CAPITAL ADVANTAGE INSURANCE COMPANY	Capital Advantage Insurance Company	seniorblueppo.capbluecross.com	MA - ER Non-Calendar w Rx (PPO)	01	04		1			H3923	803	0	2015	National		1	2	2			2							seniorblueppo.capbluecross.com	https://seniorblueppo.capbluecross.com/PharmacyInformation/	https://seniorblueppo.capbluecross.com/PharmacyInformation/	(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(866)987-4213		(866)987-4213		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		1	1	011111111111111111111111111111011011	2		1					
H3924	054	0	1	04	01	H3924_054_0	6		1	07/11/2014	2015.02	07/11/2014 03:46:44 PM Eastern Daylight Time	08/06/2014 11:17:03 AM Eastern Daylight Time	08/05/2014 12:57:24 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Essential Rx (PPO)	01	04		1			H3924	054	0	2015	Carbon, Lehigh, and Northampton Counties		2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	059	3	1	04	01	H3924_059_3	5		1	07/11/2014	2015.02	07/11/2014 03:47:13 PM Eastern Daylight Time	08/05/2014 12:51:27 PM Eastern Daylight Time	08/05/2014 01:04:38 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	3	2015	Pennsylvania	South - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	059	4	1	04	01	H3924_059_4	5		1	07/11/2014	2015.02	07/11/2014 03:47:36 PM Eastern Daylight Time	08/05/2014 12:52:40 PM Eastern Daylight Time	08/05/2014 01:05:24 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Advantage Rx (PPO)	01	04		1			H3924	059	4	2015	Pennsylvania	Southeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	060	3	1	04	01	H3924_060_3	6		1	08/06/2014	2015.02	08/06/2014 06:14:26 PM Eastern Daylight Time	08/05/2014 04:29:31 PM Eastern Daylight Time	08/05/2014 12:59:36 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	3	2015	Pennsylvania	South - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	060	4	1	04	01	H3924_060_4	6		1	08/06/2014	2015.02	08/06/2014 06:15:46 PM Eastern Daylight Time	08/05/2014 04:30:11 PM Eastern Daylight Time	08/05/2014 01:00:26 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Complete Rx (PPO)	01	04		1			H3924	060	4	2015	Pennsylvania	Southeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	061	1	1	04	01	H3924_061_1	5		1	07/11/2014	2015.02	07/11/2014 03:50:55 PM Eastern Daylight Time	08/05/2014 12:55:06 PM Eastern Daylight Time	08/05/2014 01:06:40 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Select Rx (PPO)	01	04		1			H3924	061	1	2015	Pennsylvania	Central - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	061	2	1	04	01	H3924_061_2	5		1	07/11/2014	2015.02	07/11/2014 03:52:12 PM Eastern Daylight Time	08/05/2014 12:55:50 PM Eastern Daylight Time	08/05/2014 01:07:08 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Select Rx (PPO)	01	04		1			H3924	061	2	2015	Pennsylvania	Northeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	061	5	1	04	01	H3924_061_5	5		1	07/11/2014	2015.02	07/11/2014 03:53:45 PM Eastern Daylight Time	08/05/2014 01:04:46 PM Eastern Daylight Time	08/05/2014 01:07:36 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Select Rx (PPO)	01	04		1			H3924	061	5	2015	Pennsylvania	West - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H3924	801	0	1	04	01	H3924_801_0	5		1	07/01/2014	2015.02	07/01/2014 02:36:17 PM Eastern Daylight Time	06/23/2014 01:02:16 PM Eastern Daylight Time				07/01/2014 04:03:17 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred (Employer Group) (PPO)	01	04		1			H3924	801	0	2015	Pennsylvania		1		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										1	1	011110010010100111110001011110000110	2		1					
H3924	802	0	1	04	01	H3924_802_0	5		1	07/01/2014	2015.02	07/01/2014 02:36:35 PM Eastern Daylight Time	06/23/2014 01:03:06 PM Eastern Daylight Time				07/01/2014 04:03:17 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Preferred Rx (Employer Group) (PPO)	01	04		1			H3924	802	0	2015	Pennsylvania		1		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111110010100111110001011110000110	2		1					
H3925	001	0	1	20	08	H3925_001_0	1		1	05/27/2014	2015.01	05/27/2014 01:49:42 PM Eastern Daylight Time		05/22/2014 08:48:22 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifejohnstown.com	Senior LIFE Johnstown Dual Eligible (PACE)	08	20		1			H3925	001	0	2015	Senior LIFE Cambria Somerset County Dual		2	200	2			2								NA	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H3925	002	0	1	20	08	H3925_002_0	1		1	05/27/2014	2015.01	05/27/2014 09:07:32 AM Eastern Daylight Time		05/22/2014 08:48:22 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	PENNSYLVANIA PACE, INC.	Senior LIFE Johnstown	www.seniorlifejohnstown.com	Senior LIFE Johnstown MC Only (PACE)	08	20		1			H3925	002	0	2015	Senior LIFE Cambria Somerset County MC Only		2	3	2			2								NA	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H3928	001	0	1	01	01	H3928_001_0	7		1	08/02/2014	2015.01	08/02/2014 10:22:04 AM Eastern Daylight Time	08/04/2014 05:32:02 PM Eastern Daylight Time	08/01/2014 09:39:50 AM Eastern Daylight Time			08/05/2014 02:24:13 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care of Louisiana, Inc.	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	001	0	2015	New Orleans/Baton Rouge Metro Parishes		2	1000	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)893-4689		(855)893-4689		(866)295-1824		(866)295-1824		(855)893-4689		(855)893-4689		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3928	002	0	1	01	01	H3928_002_0	8		1	08/02/2014	2015.01	08/02/2014 10:29:12 AM Eastern Daylight Time	08/04/2014 05:19:58 PM Eastern Daylight Time	08/01/2014 09:40:01 AM Eastern Daylight Time			08/05/2014 02:24:13 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care of Louisiana, Inc.	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	002	0	2015	Caddo		2	1000	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)893-4689		(855)893-4689		(866)295-1824		(866)295-1824		(855)893-4689		(855)893-4689		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3928	801	0	1	01	01	H3928_801_0	1		1	04/28/2014	2015.01	04/28/2014 03:01:38 PM Eastern Daylight Time	05/31/2014 09:24:00 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care of Louisiana, Inc.	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	801	0	2015	Louisiana - Employer Group Plan CYD with RX		1	100	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)893-4689		(855)893-4689		(866)295-1824		(866)295-1824		(855)893-4689		(855)893-4689		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100001000000000110010001100000100	2		1					1
H3928	803	0	1	01	01	H3928_803_0	1		1	04/28/2014	2015.01	04/28/2014 03:29:31 PM Eastern Daylight Time	05/31/2014 09:23:56 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF LOUISIANA, INC.	Coventry Health Care of Louisiana, Inc.	http://www.la.chcadvantra.com	Advantra (HMO)	01	01		1			H3928	803	0	2015	Louisiana Employer Group CYD No RX		1	100	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://LAformulary.coventry-medicare.com	http://www.PharmacyLocator.coventry-medicare.com	(888)360-6626		(888)360-6626		(855)893-4689		(855)893-4689										(711)-		(711)-		(711)-		(711)-										1	1	011100001000000000110000001100000100	2		1					1
H3931	004	0	1	01	01	H3931_004_0	5		1	06/01/2014	2015.01	06/01/2014 02:36:36 AM Eastern Daylight Time	08/04/2014 08:40:04 PM Eastern Daylight Time	08/01/2014 09:40:11 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3931	004	0	2015	Bucks, Chester and Delaware Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	054	0	1	01	01	H3931_054_0	3		1	06/01/2014	2015.01	06/01/2014 11:22:17 AM Eastern Daylight Time	06/01/2014 12:45:38 PM Eastern Daylight Time				07/13/2014 09:35:24 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3931	054	0	2015	Central and NE PA		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					2					2
H3931	055	0	1	01	01	H3931_055_0	3		1	06/01/2014	2015.01	06/01/2014 02:37:45 AM Eastern Daylight Time	06/01/2014 09:23:22 PM Eastern Daylight Time				07/13/2014 09:35:24 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Basic Plan (HMO)	01	01		1			H3931	055	0	2015	Bucks, Chester, Delaware and Montgomery Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					2					2
H3931	058	0	1	01	01	H3931_058_0	4		1	06/01/2014	2015.01	06/01/2014 02:38:48 AM Eastern Daylight Time	08/04/2014 08:39:18 PM Eastern Daylight Time	08/01/2014 09:40:22 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3931	058	0	2015	Philadelphia County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	064	0	1	01	01	H3931_064_0	4		1	07/13/2014	2015.01	07/13/2014 07:54:44 PM Eastern Daylight Time	08/04/2014 08:38:38 PM Eastern Daylight Time	08/01/2014 09:40:32 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	064	0	2015	Bucks, Chester and Delaware Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	065	0	1	01	01	H3931_065_0	4		1	07/13/2014	2015.01	07/13/2014 07:55:05 PM Eastern Daylight Time	08/04/2014 08:38:02 PM Eastern Daylight Time	08/01/2014 09:40:43 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	065	0	2015	Philadelphia County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	070	0	1	01	01	H3931_070_0	4		1	08/03/2014	2015.01	08/03/2014 01:35:07 PM Eastern Daylight Time	08/04/2014 08:37:20 PM Eastern Daylight Time	08/01/2014 09:40:53 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	070	0	2015	Central and NE PA		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	081	0	1	01	01	H3931_081_0	4		1	08/02/2014	2015.01	08/02/2014 01:45:15 PM Eastern Daylight Time	08/04/2014 05:23:52 PM Eastern Daylight Time	08/01/2014 09:41:03 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	081	0	2015	Raleigh and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	082	0	1	01	01	H3931_082_0	4		1	08/02/2014	2015.01	08/02/2014 01:45:40 PM Eastern Daylight Time	08/04/2014 05:24:14 PM Eastern Daylight Time	08/01/2014 09:51:08 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H3931	082	0	2015	Charlotte and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	083	0	1	01	01	H3931_083_0	3		1	07/14/2014	2015.01	07/14/2014 10:54:29 AM Eastern Daylight Time	08/04/2014 08:36:48 PM Eastern Daylight Time	08/01/2014 09:51:18 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H3931	083	0	2015	Montgomery County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	084	0	1	01	01	H3931_084_0	3		1	07/14/2014	2015.01	07/14/2014 10:58:16 AM Eastern Daylight Time	08/04/2014 08:36:08 PM Eastern Daylight Time	08/01/2014 09:51:28 AM Eastern Daylight Time			08/06/2014 09:59:55 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H3931	084	0	2015	Montgomery County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	087	0	1	01	01	H3931_087_0	4		1	08/02/2014	2015.01	08/02/2014 01:46:13 PM Eastern Daylight Time	08/04/2014 05:30:44 PM Eastern Daylight Time	08/01/2014 09:51:47 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H3931	087	0	2015	Raleigh and Surrounding area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	088	0	1	01	01	H3931_088_0	7		1	07/14/2014	2015.01	07/14/2014 10:58:04 AM Eastern Daylight Time	08/06/2014 01:23:17 PM Eastern Daylight Time	08/01/2014 09:51:57 AM Eastern Daylight Time			08/06/2014 01:24:43 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plus Plan (HMO)	01	01		1			H3931	088	0	2015	North Carolina and Kentucky		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	090	0	1	01	01	H3931_090_0	3		1	08/03/2014	2015.01	08/03/2014 04:52:36 PM Eastern Daylight Time	08/04/2014 07:54:36 PM Eastern Daylight Time	08/01/2014 09:52:07 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H3931	090	0	2015	Boone, Campbell and Kenton counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	091	0	1	01	01	H3931_091_0	4		1	08/05/2014	2015.01	08/05/2014 12:38:24 PM Eastern Daylight Time	08/04/2014 08:35:24 PM Eastern Daylight Time	08/01/2014 09:52:16 AM Eastern Daylight Time			08/06/2014 10:40:53 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PinnacleHealth Prime Plan (HMO)	01	01		1			H3931	091	0	2015	Cumberland and Dauphin counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3931	801	0	1	01	01	H3931_801_0	1		1	05/23/2014	2015.01	05/23/2014 12:45:27 PM Eastern Daylight Time	05/30/2014 09:43:00 PM Eastern Daylight Time				05/31/2014 10:46:50 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H3931	801	0	2015	Pennsylvania		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H3931	804	0	1	01	01	H3931_804_0	1		1	05/23/2014	2015.01	05/23/2014 12:46:50 PM Eastern Daylight Time	05/30/2014 09:47:34 PM Eastern Daylight Time				05/31/2014 10:46:50 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H3931	804	0	2015	Pennsylvania		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H3931	806	0	1	01	01	H3931_806_0	1		1	05/29/2014	2015.01	05/29/2014 09:19:28 AM Eastern Daylight Time	05/30/2014 11:46:56 PM Eastern Daylight Time				05/31/2014 10:46:50 AM Eastern Daylight Time	AETNA HEALTH, INC, (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan with NCY Rx (HMO)	01	01		1			H3931	806	0	2015	Pennsylvania		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H3942	001	0	1	20	08	H3942_001_0	1		1	05/27/2014	2015.01	05/27/2014 10:51:20 AM Eastern Daylight Time		05/23/2014 04:01:24 PM Eastern Daylight Time			05/28/2014 07:20:36 AM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	001	0	2015	Elderhaus PACE		2		2			2								www.elderhaus.com	www.elderhaus.com									(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209										(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209												
H3942	002	0	1	20	08	H3942_002_0	1		1	05/27/2014	2015.01	05/27/2014 10:52:04 AM Eastern Daylight Time		05/23/2014 04:10:23 PM Eastern Daylight Time			05/28/2014 07:20:36 AM Eastern Daylight Time	ELDERHAUS INC.	Elderhaus PACE	http://www.elderhaus.com	Elderhaus PACE (PACE)	08	20		1			H3942	002	0	2015	Elderhaus PACE		2		2			2								www.elderhaus.com	www.elderhaus.com									(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209										(888)343-8209		(910)343-8209		(888)343-8209		(910)343-8209												
H3945	002	0	1	01	01	H3945_002_0	5		1	07/16/2014	2015.02	07/16/2014 02:16:55 PM Central Daylight Time	08/04/2014 10:34:22 AM Central Daylight Time	07/31/2014 03:51:03 PM Central Daylight Time			08/05/2014 09:57:48 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H3945	002	0	2015	Lake, Indiana		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3945	003	0	1	02	01	H3945_003_0	6		1	07/16/2014	2015.02	07/16/2014 02:17:18 PM Central Daylight Time	08/04/2014 10:34:34 AM Central Daylight Time	07/31/2014 03:51:13 PM Central Daylight Time			08/05/2014 09:57:48 AM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H3945	003	0	2015	Lake, Indiana		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3945	801	0	1	01	01	H3945_801_0	1		1	05/09/2014	2015.02	05/09/2014 02:23:56 PM Central Daylight Time	05/29/2014 07:30:20 PM Central Daylight Time				05/29/2014 11:50:29 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H3945	801	0	2015	Statewide IN and AR		1		2			2							wwww.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000100	1	110000111011011111110010110	1					1
H3945	802	0	1	02	01	H3945_802_0	1		1	04/29/2014	2015.02	04/29/2014 10:26:50 PM Central Daylight Time	05/29/2014 07:30:40 PM Central Daylight Time				05/29/2014 11:50:29 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H3945	802	0	2015	Statewide IN and AR		1		2			2							wwww.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	2		2		1
H3945	803	0	1	01	01	H3945_803_0	1		1	04/29/2014	2015.02	04/29/2014 10:30:12 PM Central Daylight Time	05/29/2014 07:31:01 PM Central Daylight Time				05/29/2014 11:50:29 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H3945	803	0	2015	Statewide IN and AR		1		2			2							wwww.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H3945	804	0	1	02	01	H3945_804_0	1		1	04/29/2014	2015.02	04/29/2014 10:37:35 PM Central Daylight Time	05/29/2014 07:32:26 PM Central Daylight Time				05/29/2014 11:50:29 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H3945	804	0	2015	Statewide IN and AR		1		2			2							wwww.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	2		2		1
H3945	805	0	1	01	01	H3945_805_0	1		1	04/29/2014	2015.02	04/29/2014 10:43:55 PM Central Daylight Time	05/29/2014 07:32:48 PM Central Daylight Time				05/29/2014 11:50:29 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H3945	805	0	2015	Statewide IN and AR		1		2			2							wwww.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H3945	806	0	1	02	01	H3945_806_0	1		1	04/29/2014	2015.02	04/29/2014 10:48:08 PM Central Daylight Time	05/29/2014 07:33:08 PM Central Daylight Time				05/29/2014 11:50:29 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H3945	806	0	2015	Statewide IN and AR		1		2			2							wwww.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)886-1993		(888)886-1993										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	2		2		1
H3949	009	0	1	01	01	H3949_009_0	7	2	1	07/16/2014	2015.02	07/16/2014 03:18:58 PM Eastern Daylight Time	08/04/2014 01:45:38 PM Central Daylight Time	07/31/2014 03:53:10 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H3949	009	0	2015	Select Pennsylvania Counties		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	013	0	1	01	01	H3949_013_0	5		1	07/16/2014	2015.02	07/16/2014 03:12:31 PM Eastern Daylight Time	05/30/2014 08:25:38 AM Central Daylight Time	07/31/2014 03:53:21 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Plus (HMO)	01	01		1			H3949	013	0	2015	Philadelphia Metro Areas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	016	0	1	01	01	H3949_016_0	6		1	08/01/2014	2015.02	08/01/2014 03:08:29 PM Eastern Daylight Time	08/04/2014 01:46:07 PM Central Daylight Time	07/31/2014 03:53:32 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Traditions (HMO SNP)	01	01		1			H3949	016	0	2015	Select Pennsylvania Counties		2		2			1	1	1	1				www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	024	0	1	01	01	H3949_024_0	5		1	07/16/2014	2015.02	07/16/2014 03:13:06 PM Eastern Daylight Time	05/30/2014 08:26:18 AM Central Daylight Time	07/31/2014 03:53:42 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Achieve (HMO SNP)	01	01		1			H3949	024	0	2015	Select Pennsylvania Counties		2		2			1	4		1		00000010000000000000		www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	026	0	1	01	01	H3949_026_0	3		1	07/16/2014	2015.02	07/16/2014 03:13:19 PM Eastern Daylight Time	05/30/2014 08:26:38 AM Central Daylight Time				07/18/2014 12:05:58 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H3949	026	0	2015	Philadelphia, Montgomery and Bucks Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										2					2					2
H3949	027	0	1	02	01	H3949_027_0	5		1	07/16/2014	2015.02	07/16/2014 03:13:31 PM Eastern Daylight Time	08/04/2014 01:46:45 PM Central Daylight Time	07/31/2014 03:53:53 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H3949	027	0	2015	Philadelphia, Montgomery and Bucks Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	028	0	1	01	01	H3949_028_0	5		1	07/16/2014	2015.02	07/16/2014 03:16:27 PM Eastern Daylight Time	05/30/2014 08:27:18 AM Central Daylight Time	07/31/2014 03:54:03 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring PreventiveCare (HMO)	01	01		1			H3949	028	0	2015	Philadelphia and Bucks Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	029	1	1	01	01	H3949_029_1	5		1	07/16/2014	2015.02	07/16/2014 03:13:59 PM Eastern Daylight Time	05/30/2014 08:27:39 AM Central Daylight Time	07/31/2014 03:54:13 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H3949	029	1	2015	Pennsylvania	Pennsylvania Preferred	2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	029	2	1	01	01	H3949_029_2	6		1	07/16/2014	2015.02	07/16/2014 03:14:13 PM Eastern Daylight Time	05/30/2014 08:27:59 AM Central Daylight Time	07/31/2014 03:54:24 PM Central Daylight Time			08/05/2014 10:14:45 AM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H3949	029	2	2015	Pennsylvania	Pennsylvania Preferred Select Counties	2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(800)668-3813		(800)668-3813		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3949	804	0	1	01	01	H3949_804_0	2		1	05/06/2014	2015.02	05/06/2014 11:40:31 AM Eastern Daylight Time	05/30/2014 08:28:20 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H3949	804	0	2015	Statewide PA		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010110111111111011101001110	1	000000101000000000000010000	1					1
H3949	806	0	1	02	01	H3949_806_0	2		1	05/06/2014	2015.02	05/06/2014 11:36:47 AM Eastern Daylight Time	05/30/2014 08:28:40 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H3949	806	0	2015	Statewide PA		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010110111111111011101001110	1	000000101000000000000010000	1	1	011111111111111111111111111111111111	1	000000101000000000000010000	1
H3949	807	0	1	01	01	H3949_807_0	2		1	05/06/2014	2015.02	05/06/2014 11:13:11 AM Eastern Daylight Time	05/30/2014 08:29:00 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H3949	807	0	2015	Statewide PA		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										1	1	011111111010110111111111011101001110	1	000000101000000000000010000	1					1
H3949	808	0	1	01	01	H3949_808_0	2		1	05/06/2014	2015.02	05/06/2014 11:14:24 AM Eastern Daylight Time	05/30/2014 08:29:20 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H3949	808	0	2015	Statewide PA		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010110111111111011101001110	1	000000101000000000000010000	1					1
H3949	809	0	1	02	01	H3949_809_0	2		1	05/06/2014	2015.02	05/06/2014 11:04:28 AM Eastern Daylight Time	05/30/2014 08:29:40 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H3949	809	0	2015	Statewide PA		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657										(711)-		(711)-		(711)-		(711)-										1	1	011111111010110111111111011101001110	1	000000101000000000000010000	1	1	011111111111111111111111111111111111	1	000000101000000000000010000	1
H3949	810	0	1	02	01	H3949_810_0	2		1	05/06/2014	2015.02	05/06/2014 11:05:50 AM Eastern Daylight Time	05/30/2014 08:30:01 AM Central Daylight Time				05/30/2014 01:37:58 PM Central Daylight Time	BRAVO HEALTH PENNSYLVANIA, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H3949	810	0	2015	Statewide PA		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(888)281-7867		(888)281-7867		(800)856-7657		(800)856-7657		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010110111111111011101001110	1	000000101000000000000010000	1	1	011111111111111111111111111111111111	1	000000101000000000000010000	1
H3952	008	0	1	01	01	H3952_008_0	2		1	05/27/2014	2015.01	05/27/2014 08:05:52 AM Eastern Daylight Time	05/31/2014 06:41:13 PM Eastern Daylight Time				06/01/2014 12:38:50 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	008	0	2015	Bucks, Philadelphia Counties		2	10000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2
H3952	020	0	1	01	01	H3952_020_0	6		1	05/27/2014	2015.01	05/27/2014 11:46:59 AM Eastern Daylight Time	08/05/2014 02:50:04 PM Eastern Daylight Time	08/05/2014 05:11:40 PM Eastern Daylight Time			08/06/2014 08:21:56 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	020	0	2015	Bucks, Philadelphia Counties		2	50000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3952	044	0	1	01	01	H3952_044_0	3		1	05/27/2014	2015.01	05/27/2014 08:06:37 AM Eastern Daylight Time	06/04/2014 03:42:04 PM Eastern Daylight Time				06/10/2014 09:34:51 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Medical Only (HMO)	01	01		1			H3952	044	0	2015	Chester, Delaware, Montgomery Counties		2	2000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2
H3952	045	0	1	01	01	H3952_045_0	5		1	05/27/2014	2015.01	05/27/2014 11:47:46 AM Eastern Daylight Time	08/05/2014 02:53:30 PM Eastern Daylight Time	08/05/2014 05:12:27 PM Eastern Daylight Time			08/06/2014 08:21:56 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Preferred Rx (HMO)	01	01		1			H3952	045	0	2015	Chester, Delaware, Montgomery Counties		2	10000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3952	048	0	1	01	01	H3952_048_0	1		1	05/28/2014	2015.01	05/28/2014 09:37:01 AM Eastern Daylight Time	05/31/2014 06:44:56 PM Eastern Daylight Time				06/01/2014 12:49:26 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	048	0	2015	Bucks, Philadelphia Counties		2	20000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2
H3952	049	0	1	01	01	H3952_049_0	6		1	05/28/2014	2015.01	05/28/2014 09:37:37 AM Eastern Daylight Time	08/05/2014 02:48:36 PM Eastern Daylight Time	08/05/2014 05:13:23 PM Eastern Daylight Time			08/06/2014 08:21:56 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	049	0	2015	Bucks, Philadelphia Counties		2	30000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3952	050	0	1	01	01	H3952_050_0	1		1	05/28/2014	2015.01	05/28/2014 09:35:38 AM Eastern Daylight Time	05/31/2014 06:47:28 PM Eastern Daylight Time				06/01/2014 12:53:55 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Medical Only (HMO)	01	01		1			H3952	050	0	2015	Chester, Deleware, Montgomery Counties		2	10000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										2					2					2
H3952	051	0	1	01	01	H3952_051_0	4		1	05/28/2014	2015.01	05/28/2014 09:38:01 AM Eastern Daylight Time	08/05/2014 02:51:22 PM Eastern Daylight Time	08/05/2014 05:13:51 PM Eastern Daylight Time			08/06/2014 08:21:56 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Select Rx (HMO)	01	01		1			H3952	051	0	2015	Chester, Delaware, Montgomery Counties		2	10000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3952	052	0	1	01	01	H3952_052_0	4		1	08/05/2014	2015.01	08/05/2014 05:25:06 PM Eastern Daylight Time	08/05/2014 02:45:35 PM Eastern Daylight Time	08/05/2014 05:14:11 PM Eastern Daylight Time			08/06/2014 08:25:50 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Basic Rx (HMO)	01	01		1			H3952	052	0	2015	Bucks, Philadelphia Counties		2	6000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3952	802	0	1	01	01	H3952_802_0	2		1	05/28/2014	2015.01	05/28/2014 02:40:51 PM Eastern Daylight Time	06/04/2014 02:46:17 PM Eastern Daylight Time				06/10/2014 09:34:51 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Medical Only (HMO)	01	01		1			H3952	802	0	2015	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	2000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733										(711)-		(711)-		(711)-		(711)-										1	1	011100011000000000111110011110000100	1	100000111011010111000000001	1					1
H3952	804	0	1	01	01	H3952_804_0	1		1	05/28/2014	2015.01	05/28/2014 02:40:21 PM Eastern Daylight Time	06/01/2014 11:31:15 AM Eastern Daylight Time				06/01/2014 01:05:12 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN EAST, INC.	Keystone 65 HMO	www.ibxmedicare.com	Keystone 65 Group Rx (HMO)	01	01		1			H3952	804	0	2015	Bucks,Chester,Delaware,Montgomery,Philadelphia Cty		1	8000	2			2							www.ibxmedicare.com	www.ibxmedicare.com	www.ibxmedicare.com	(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(800)645-3965		(800)645-3965		(877)393-6733		(877)393-6733		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011000000000111110011110000100	1	100000111011010111000000001	1					1
H3954	097	0	1	01	01	H3954_097_0	3	2	1	08/06/2014	2015.02	08/06/2014 06:01:57 PM Eastern Daylight Time	08/05/2014 12:34:43 PM Eastern Daylight Time	08/05/2014 01:08:17 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Secure Rx (HMO SNP)	01	01		1			H3954	097	0	2015	Central and Northeast Pennsylvania		2		2			1	3		1	3		1	www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	146	0	1	01	01	H3954_146_0	6		1	07/18/2014	2015.02	07/18/2014 06:29:58 PM Eastern Daylight Time	08/05/2014 12:35:38 PM Eastern Daylight Time	08/05/2014 01:08:45 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Classic Rx (HMO)	01	01		1			H3954	146	0	2015	Monmouth and Ocean Counties, New Jersey		2		2			2							www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376		(800)988-4861		(570)271-8771		(800)419-1376		(800)419-1376		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	156	1	1	01	01	H3954_156_1	3		1	07/11/2014	2015.02	07/11/2014 03:59:29 PM Eastern Daylight Time	07/09/2014 10:23:35 AM Eastern Daylight Time				07/15/2014 08:24:46 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	1	2015	Pennsylvania	Central - Pennsylvania	2		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2
H3954	156	2	1	01	01	H3954_156_2	3		1	07/11/2014	2015.02	07/11/2014 04:20:19 PM Eastern Daylight Time	07/09/2014 10:33:13 AM Eastern Daylight Time				07/15/2014 08:24:46 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	2	2015	Pennsylvania	Northeast - Pennsylvania	2		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2
H3954	156	3	1	01	01	H3954_156_3	3		1	07/14/2014	2015.02	07/14/2014 03:02:31 PM Eastern Daylight Time	07/09/2014 10:35:07 AM Eastern Daylight Time				07/15/2014 08:24:46 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	3	2015	Pennsylvania	South - Pennsylvania	2		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2
H3954	156	4	1	01	01	H3954_156_4	3		1	07/11/2014	2015.02	07/11/2014 04:22:29 PM Eastern Daylight Time	07/09/2014 10:29:22 AM Eastern Daylight Time				07/15/2014 08:24:46 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	4	2015	Pennsylvania	Southeast - Pennsylvania	2		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2
H3954	156	5	1	01	01	H3954_156_5	3		1	07/11/2014	2015.02	07/11/2014 04:23:31 PM Eastern Daylight Time	07/09/2014 10:37:45 AM Eastern Daylight Time				07/15/2014 08:24:46 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage (HMO)	01	01		1			H3954	156	5	2015	Pennsylvania	West - Pennsylvania	2		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										2					2					2
H3954	157	1	1	01	01	H3954_157_1	4		1	07/11/2014	2015.02	07/11/2014 04:31:40 PM Eastern Daylight Time	08/05/2014 04:31:01 PM Eastern Daylight Time	08/05/2014 01:09:18 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	1	2015	Pennsylvania	Central - Pennsylvania	2	1000	2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	157	2	1	01	01	H3954_157_2	4		1	07/11/2014	2015.02	07/11/2014 04:32:02 PM Eastern Daylight Time	08/05/2014 04:31:44 PM Eastern Daylight Time	08/05/2014 01:09:47 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	2	2015	Pennsylvania	Northeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	157	3	1	01	01	H3954_157_3	4		1	07/11/2014	2015.02	07/11/2014 04:32:19 PM Eastern Daylight Time	08/05/2014 04:33:21 PM Eastern Daylight Time	08/05/2014 01:10:21 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	3	2015	Pennsylvania	South - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	157	4	1	01	01	H3954_157_4	4		1	07/11/2014	2015.02	07/11/2014 04:33:01 PM Eastern Daylight Time	08/05/2014 04:34:33 PM Eastern Daylight Time	08/05/2014 01:10:49 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	4	2015	Pennsylvania	Southeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	157	5	1	01	01	H3954_157_5	4		1	07/11/2014	2015.02	07/11/2014 04:33:23 PM Eastern Daylight Time	08/05/2014 04:35:15 PM Eastern Daylight Time	08/05/2014 01:11:23 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Advantage Rx (HMO)	01	01		1			H3954	157	5	2015	Pennsylvania	West - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	158	1	1	01	01	H3954_158_1	6		1	07/18/2014	2015.02	07/18/2014 06:30:32 PM Eastern Daylight Time	08/05/2014 11:06:27 AM Eastern Daylight Time	08/05/2014 01:12:36 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	1	2015	Pennsylvania	Central - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	158	2	1	01	01	H3954_158_2	5		1	07/21/2014	2015.02	07/21/2014 10:57:39 AM Eastern Daylight Time	08/05/2014 11:07:50 AM Eastern Daylight Time	08/05/2014 01:13:04 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	2	2015	Pennsylvania	Northeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	158	3	1	01	01	H3954_158_3	5		1	07/21/2014	2015.02	07/21/2014 10:57:27 AM Eastern Daylight Time	08/05/2014 11:08:57 AM Eastern Daylight Time	08/05/2014 01:13:35 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	3	2015	Pennsylvania	South - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	158	4	1	01	01	H3954_158_4	5		1	07/18/2014	2015.02	07/18/2014 06:31:29 PM Eastern Daylight Time	08/05/2014 11:10:06 AM Eastern Daylight Time	08/05/2014 01:14:03 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	4	2015	Pennsylvania	Southeast - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	158	5	1	01	01	H3954_158_5	6		1	07/18/2014	2015.02	07/18/2014 06:31:49 PM Eastern Daylight Time	08/05/2014 11:11:07 AM Eastern Daylight Time	08/05/2014 01:14:31 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Complete Rx (HMO)	01	01		1			H3954	158	5	2015	Pennsylvania	West - Pennsylvania	2		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)988-4861		(570)271-8771		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3954	801	0	1	01	01	H3954_801_0	4		1	06/02/2014	2015.02	06/02/2014 03:02:20 PM Eastern Daylight Time	06/12/2014 10:23:30 AM Eastern Daylight Time				06/16/2014 11:24:46 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic (Employer Group) (HMO)	01	01		1			H3954	801	0	2015	Pennsylvania		1		2			2							www.GeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-										1	1	011111110010100111110001011110000110	1	000001111011010000110110000	1					1
H3954	802	0	1	01	01	H3954_802_0	4		1	06/02/2014	2015.02	06/02/2014 03:04:05 PM Eastern Daylight Time	06/12/2014 10:28:01 AM Eastern Daylight Time				06/16/2014 11:24:46 AM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Classic Rx (Employer Group) (HMO)	01	01		1			H3954	802	0	2015	Pennsylvania		1		2			2							www.GeisingerGold.com	www.GeisingerGold.com	www.GeisingerGold.com	(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138		(800)988-4861		(570)271-8771		(800)514-0138		(800)514-0138		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111110010100111110001011110000110	1	000001111011010000110110000	1					1
H3954	803	0	1	01	01	H3954_803_0	5		1	06/02/2014	2015.02	06/02/2014 03:04:21 PM Eastern Daylight Time	07/17/2014 10:31:57 AM Eastern Daylight Time				07/22/2014 12:08:15 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Classic 100 (Employer Group) (HMO)	01	01		1			H3954	803	0	2015	New Jersey		1		2			2							www.MeridianGeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376										(711)-		(711)-		(711)-		(711)-										1	1	011111110010100111110001011110000110	1	000001111011010000110110000	1					1
H3954	804	0	1	01	01	H3954_804_0	5		1	06/02/2014	2015.02	06/02/2014 03:04:36 PM Eastern Daylight Time	07/17/2014 10:34:00 AM Eastern Daylight Time				07/22/2014 12:08:15 PM Eastern Daylight Time	GEISINGER HEALTH PLAN	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Classic 100 Rx (EmployerGroup) (HMO)	01	01		1			H3954	804	0	2015	New Jersey		1		2			2							www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376		(800)988-4861		(570)271-8771		(800)419-1376		(800)419-1376		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111110010100111110001011110000110	1	000001111011010000110110000	1					1
H3957	003	0	1	01	01	H3957_003_0	8		1	07/17/2014	2015.01	07/17/2014 04:12:45 PM Eastern Daylight Time	08/01/2014 09:19:28 AM Eastern Daylight Time	08/01/2014 10:54:04 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue Standard (HMO)	01	01		1			H3957	003	0	2015	Southwestern PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	006	0	1	01	01	H3957_006_0	8		1	07/17/2014	2015.01	07/17/2014 04:09:46 PM Eastern Daylight Time	08/01/2014 09:19:37 AM Eastern Daylight Time	08/01/2014 10:55:12 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue Standard (HMO)	01	01		1			H3957	006	0	2015	West Central PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	020	0	1	01	01	H3957_020_0	7		1	07/17/2014	2015.01	07/17/2014 04:09:53 PM Eastern Daylight Time	08/01/2014 09:20:45 AM Eastern Daylight Time	08/01/2014 10:56:19 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue Deluxe (HMO)	01	01		1			H3957	020	0	2015	Southwestern PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	021	0	1	01	01	H3957_021_0	7		1	07/17/2014	2015.01	07/17/2014 04:13:03 PM Eastern Daylight Time	08/01/2014 09:21:01 AM Eastern Daylight Time	08/01/2014 10:57:20 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue Deluxe (HMO)	01	01		1			H3957	021	0	2015	West Central PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	024	0	1	01	01	H3957_024_0	6		1	07/17/2014	2015.01	07/17/2014 04:08:48 PM Eastern Daylight Time	07/03/2014 08:01:11 AM Eastern Daylight Time				07/17/2014 04:42:16 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue Value (HMO)	01	01		1			H3957	024	0	2015	Southwestern PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(800)227-8210		(800)227-8210										2					2					2
H3957	025	0	1	01	01	H3957_025_0	7		1	07/17/2014	2015.01	07/17/2014 04:08:39 PM Eastern Daylight Time	07/03/2014 08:01:37 AM Eastern Daylight Time				07/17/2014 04:42:16 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue Value (HMO)	01	01		1			H3957	025	0	2015	West Central PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(800)227-8210		(800)227-8210										2					2					2
H3957	031	0	1	01	01	H3957_031_0	8		1	07/23/2014	2015.01	07/23/2014 03:04:54 PM Eastern Daylight Time	08/01/2014 09:21:19 AM Eastern Daylight Time	08/01/2014 10:58:23 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue ValueRx (HMO)	01	01		1			H3957	031	0	2015	Southwestern PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	032	0	1	01	01	H3957_032_0	8		1	07/23/2014	2015.01	07/23/2014 03:04:42 PM Eastern Daylight Time	08/01/2014 09:21:44 AM Eastern Daylight Time	08/01/2014 11:01:26 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue ValueRx (HMO)	01	01		1			H3957	032	0	2015	West Central PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	038	0	1	01	01	H3957_038_0	8		1	07/18/2014	2015.01	07/18/2014 11:48:54 AM Eastern Daylight Time	08/01/2014 12:50:05 PM Eastern Daylight Time	08/01/2014 11:03:03 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Community Blue Medicare Signature (HMO)	01	01		1			H3957	038	0	2015	Western PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	039	0	1	01	01	H3957_039_0	10		1	07/31/2014	2015.01	07/31/2014 09:14:27 AM Eastern Daylight Time	08/01/2014 09:22:28 AM Eastern Daylight Time	08/01/2014 11:04:06 AM Eastern Daylight Time			08/05/2014 09:44:26 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Community Blue Medicare Prestige (HMO)	01	01		1			H3957	039	0	2015	Western PA		2		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(888)234-5397		(888)234-5397		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					2
H3957	805	0	1	01	01	H3957_805_0	5		1	05/07/2014	2015.01	05/07/2014 10:04:56 AM Eastern Daylight Time	07/03/2014 08:34:37 AM Eastern Daylight Time				07/11/2014 03:44:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue MA (HMO)	01	01		1			H3957	805	0	2015	Western PA		1		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	011111111110100111111111001110000110	2		1					1
H3957	806	0	1	01	01	H3957_806_0	5		1	05/07/2014	2015.01	05/07/2014 10:09:07 AM Eastern Daylight Time	07/03/2014 08:34:55 AM Eastern Daylight Time				07/11/2014 03:44:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue MA-PD (HMO)	01	01		1			H3957	806	0	2015	Western PA		1		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					1
H3957	808	0	1	01	01	H3957_808_0	5		1	05/07/2014	2015.01	05/07/2014 10:11:34 AM Eastern Daylight Time	07/03/2014 08:35:13 AM Eastern Daylight Time				07/11/2014 03:44:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Security Blue MA-PD Non-Calendar (HMO)	01	01		1			H3957	808	0	2015	Western PA		1		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(800)935-2583		(800)935-2583		(866)670-5844		(866)670-5844		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					1
H3957	810	0	1	01	01	H3957_810_0	3		1	05/22/2014	2015.01	05/22/2014 11:16:38 AM Eastern Daylight Time	07/03/2014 08:35:37 AM Eastern Daylight Time				07/11/2014 03:44:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Community Blue Medicare MA (HMO)	01	01		1			H3957	810	0	2015	Western PA		1		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	011111111110100111111111001110000110	2		1					1
H3957	811	0	1	01	01	H3957_811_0	4		1	05/22/2014	2015.01	05/22/2014 11:16:55 AM Eastern Daylight Time	07/03/2014 08:35:59 AM Eastern Daylight Time				07/11/2014 03:44:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Community Blue Medicare MA-PD (HMO)	01	01		1			H3957	811	0	2015	Western PA		1		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					1
H3957	812	0	1	01	01	H3957_812_0	4		1	05/22/2014	2015.01	05/22/2014 11:17:12 AM Eastern Daylight Time	07/03/2014 08:36:21 AM Eastern Daylight Time				07/11/2014 03:44:49 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN WEST, INC.	Keystone Health Plan West, Inc.	www.highmarkbcbs.com/medicare	Community Blue Medicare MA-PD Non-Calendar (HMO)	01	01		1			H3957	812	0	2015	Western PA		1		2			2							www.highmarkbcbs.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbs.com/medicare	(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(888)234-5368		(888)234-5368		(866)687-3182		(866)687-3182		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					1
H3959	001	0	1	01	01	H3959_001_0	3		1	08/04/2014	2015.01	08/04/2014 09:48:59 AM Eastern Daylight Time	08/05/2014 11:38:18 AM Eastern Daylight Time	08/01/2014 09:52:27 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	001	0	2015	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)290-6660		(866)290-6660		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	002	0	1	01	01	H3959_002_0	4		1	08/04/2014	2015.01	08/04/2014 09:28:16 AM Eastern Daylight Time	08/05/2014 11:38:22 AM Eastern Daylight Time	08/01/2014 09:52:37 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	002	0	2015	Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)290-6660		(866)290-6660		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	010	0	1	01	01	H3959_010_0	3		1	08/04/2014	2015.01	08/04/2014 11:35:46 AM Eastern Daylight Time	08/05/2014 11:38:24 AM Eastern Daylight Time	08/01/2014 09:52:47 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	010	0	2015	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)290-6660		(866)290-6660		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	011	0	1	01	01	H3959_011_0	3		1	08/04/2014	2015.01	08/04/2014 11:36:00 AM Eastern Daylight Time	08/05/2014 11:37:30 AM Eastern Daylight Time	08/01/2014 09:52:57 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	011	0	2015	Central and Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)290-6660		(866)290-6660		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	031	0	1	01	01	H3959_031_0	3		1	08/04/2014	2015.01	08/04/2014 11:36:15 AM Eastern Daylight Time	08/05/2014 11:37:56 AM Eastern Daylight Time	08/01/2014 09:53:08 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	031	0	2015	Philadelphia and Delaware Counties		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	032	0	1	01	01	H3959_032_0	4		1	08/04/2014	2015.01	08/04/2014 12:04:24 PM Eastern Daylight Time	08/05/2014 11:37:58 AM Eastern Daylight Time	08/01/2014 09:53:18 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver Plus (HMO)	01	01		1			H3959	032	0	2015	Northwestern Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)290-6660		(866)290-6660		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	033	0	1	01	01	H3959_033_0	3		1	08/04/2014	2015.01	08/04/2014 11:36:53 AM Eastern Daylight Time	08/05/2014 11:38:02 AM Eastern Daylight Time	08/01/2014 09:53:27 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (HMO)	01	01		1			H3959	033	0	2015	Bucks, Chester and Montgomery		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	035	0	1	01	01	H3959_035_0	4	2	1	08/11/2014	2015.01	08/11/2014 11:25:33 PM Eastern Daylight Time	08/11/2014 11:36:34 PM Eastern Daylight Time	08/01/2014 09:53:38 AM Eastern Daylight Time			08/11/2014 11:42:44 PM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Cares (HMO SNP)	01	01		1			H3959	035	0	2015	Southeastern Pennsylvania		2		2			1	3		1	2			http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	036	0	1	01	01	H3959_036_0	4	2	1	08/11/2014	2015.01	08/11/2014 11:26:38 PM Eastern Daylight Time	08/11/2014 11:36:02 PM Eastern Daylight Time	08/01/2014 09:53:48 AM Eastern Daylight Time			08/11/2014 11:42:44 PM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Cares (HMO SNP)	01	01		1			H3959	036	0	2015	Central and Western Pennsylvania		2		2			1	3		1	2			http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	037	0	1	01	01	H3959_037_0	3		1	08/04/2014	2015.01	08/04/2014 11:37:08 AM Eastern Daylight Time	08/05/2014 11:38:10 AM Eastern Daylight Time	08/01/2014 09:53:57 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Northern Pennsylvania Gold (HMO)	01	01		1			H3959	037	0	2015	Northeastern Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	038	0	1	01	01	H3959_038_0	2		1	08/05/2014	2015.01	08/05/2014 09:06:33 AM Eastern Daylight Time	08/05/2014 11:38:12 AM Eastern Daylight Time	08/01/2014 09:54:07 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra UCPN Plus (HMO)	01	01		1			H3959	038	0	2015	Philadelphia County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	039	0	1	01	01	H3959_039_0	3		1	08/04/2014	2015.01	08/04/2014 11:37:35 AM Eastern Daylight Time	08/05/2014 11:38:16 AM Eastern Daylight Time	08/01/2014 09:54:17 AM Eastern Daylight Time			08/05/2014 11:56:02 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver Plus (HMO)	01	01		1			H3959	039	0	2015	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3959	041	0	1	01	01	H3959_041_0	2		1	05/30/2014	2015.01	05/30/2014 09:41:58 AM Eastern Daylight Time	05/29/2014 06:46:22 PM Eastern Daylight Time				05/30/2014 10:15:47 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Basic Medical (HMO)	01	01		1			H3959	041	0	2015	Central and Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440										(711)-		(711)-		(711)-		(711)-										2					2					2
H3959	803	0	1	01	01	H3959_803_0	1		1	05/29/2014	2015.01	05/29/2014 02:40:29 PM Eastern Daylight Time	05/31/2014 10:28:04 AM Eastern Daylight Time				05/31/2014 10:29:45 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra MA Only (HMO)	01	01		1			H3959	803	0	2015	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111111111111111011100	2		1					1
H3959	804	0	1	01	01	H3959_804_0	1		1	05/29/2014	2015.01	05/29/2014 02:38:12 PM Eastern Daylight Time	05/31/2014 10:28:24 AM Eastern Daylight Time				05/31/2014 10:29:45 AM Eastern Daylight Time	HEALTHAMERICA PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra Gold (HMO)	01	01		1			H3959	804	0	2015	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272		(866)290-6660		(866)290-6660		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111111111011100	2		1					1
H3962	001	0	1	01	01	H3962_001_0	6		1	07/11/2014	2015.01	07/11/2014 04:50:17 PM Eastern Daylight Time	06/01/2014 09:10:52 PM Eastern Daylight Time	05/31/2014 09:19:36 PM Eastern Daylight Time			07/11/2014 11:56:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	seniorbluehmo.capbluecross.com	SeniorBlue - Option 1 (HMO)	01	01		1			H3962	001	0	2015	16 Counties in Central PA		2	7251	2			2							seniorbluehmo.capbluecross.com	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		2					2					2
H3962	004	0	1	01	01	H3962_004_0	5		1	07/11/2014	2015.01	07/11/2014 04:52:07 PM Eastern Daylight Time	06/01/2014 09:12:42 PM Eastern Daylight Time	05/31/2014 09:24:40 PM Eastern Daylight Time			07/11/2014 11:56:45 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	seniorbluehmo.capbluecross.com	SeniorBlue - Option 2 (HMO)	01	01		1			H3962	004	0	2015	16 Counties in Central PA		2	1328	2			2							seniorbluehmo.capbluecross.com	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		2					2					2
H3962	007	0	1	01	01	H3962_007_0	7		1	08/06/2014	2015.01	08/06/2014 10:37:50 AM Eastern Daylight Time	08/05/2014 05:22:11 PM Eastern Daylight Time	08/01/2014 09:51:50 AM Eastern Daylight Time			08/06/2014 10:59:49 AM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	seniorbluehmo.capbluecross.com	SeniorBlue - Option 3 (HMO)	01	01		1			H3962	007	0	2015	16 Counties in Central PA		2	1634	2			2							seniorbluehmo.capbluecross.com	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		2					2					2
H3962	801	0	1	01	01	H3962_801_0	4		1	06/02/2014	2015.01	06/02/2014 07:07:31 PM Eastern Daylight Time	06/02/2014 07:07:20 PM Eastern Daylight Time				06/02/2014 08:32:46 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	seniorbluehmo.capbluecross.com	SeniorBlue ER - With Rx (HMO)	01	01		1			H3962	801	0	2015	National		1	1328	2			2							seniorbluehmo.capbluecross.com	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		1	1	011111111111111111111111111111011011	1	111111111111111111111111111	1					1
H3962	802	0	1	01	01	H3962_802_0	4		1	06/02/2014	2015.01	06/02/2014 07:08:38 PM Eastern Daylight Time	06/02/2014 07:08:50 PM Eastern Daylight Time				06/02/2014 08:32:46 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	seniorbluehmo.capbluecross.com	SeniorBlue ER - w/o Rx (HMO)	01	01		1			H3962	802	0	2015	National		1	100	2			2							seniorbluehmo.capbluecross.com	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201										(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961										1	1	011111111111111111111111111111011011	1	111111111111111111111111111	1					1
H3962	803	0	1	01	01	H3962_803_0	4		1	06/02/2014	2015.01	06/02/2014 07:09:57 PM Eastern Daylight Time	06/02/2014 07:10:44 PM Eastern Daylight Time				06/02/2014 08:32:46 PM Eastern Daylight Time	KEYSTONE HEALTH PLAN CENTRAL, INC.	Keystone Health Plan Central, Inc.	seniorbluehmo.capbluecross.com	SeniorBlue ER - Non-Calendar - with Rx (HMO)	01	01		1			H3962	803	0	2015	National		1	2	2			2							seniorbluehmo.capbluecross.com	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	https://seniorbluehmo.capbluecross.com/PharmacyInformation/	(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6962		(800)779-6962		(800)990-4201		(800)990-4201		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961		1	1	011111111111111111111111111111011011	1	111111111111111111111111111	1					1
H3979	001	0	1	01	01	H3979_001_0	8		1	08/06/2014	2015.01	08/06/2014 08:52:15 AM Central Daylight Time	08/05/2014 04:26:28 PM Central Daylight Time	08/05/2014 09:46:52 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemapd.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H3979	001	0	2015	Oklahoma City Metro Area		2	888	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3979	002	0	1	02	01	H3979_002_0	7		1	08/06/2014	2015.01	08/06/2014 08:52:46 AM Central Daylight Time	08/05/2014 04:27:16 PM Central Daylight Time	08/05/2014 09:48:26 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemapd.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H3979	002	0	2015	Oklahoma City Area		2	152	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H3979	801	0	1	01	01	H3979_801_0	3		1	06/02/2014	2015.01	06/02/2014 08:56:40 AM Central Daylight Time	07/23/2014 02:17:14 PM Central Daylight Time				07/23/2014 02:43:01 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	801	0	2015	State of Oklahoma		1	377	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H3979	803	0	1	01	01	H3979_803_0	3		1	06/02/2014	2015.01	06/02/2014 08:57:17 AM Central Daylight Time	07/23/2014 02:18:34 PM Central Daylight Time				07/23/2014 02:43:01 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	803	0	2015	State of Oklahoma		1	377	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H3979	805	0	1	01	01	H3979_805_0	3		1	06/02/2014	2015.01	06/02/2014 08:58:02 AM Central Daylight Time	07/23/2014 02:20:56 PM Central Daylight Time				07/23/2014 02:43:01 PM Central Daylight Time	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Blue Cross Blue Shield of OK	www.mybluemapd.com	BlueCross Medicare Advantage (HMO)	01	01		1			H3979	805	0	2015	State of Oklahoma		1	377	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001100000001100000000	2		1					1
H4000	001	0	1	20	08	H4000_001_0	1		1	05/20/2014	2015.01	05/20/2014 05:40:11 PM Mountain Daylight Time		05/19/2014 06:59:32 AM Mountain Daylight Time			05/20/2014 05:44:09 PM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	001-Dual Eligible (PACE)	08	20		1			H4000	001	0	2015	001-Wyoming PACE		2		2			2								www.crmcwy.org	www.seniorscript.com									(000)000-0000		(307)634-2273		(000)000-0000		(307)634-2273										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965												
H4000	002	0	1	20	08	H4000_002_0	1		1	05/20/2014	2015.01	05/20/2014 05:41:23 PM Mountain Daylight Time		05/19/2014 07:23:18 AM Mountain Daylight Time			05/20/2014 05:44:09 PM Mountain Daylight Time	MEMORIAL HOSPITAL OF LARAMIE COUNTY	Wyoming PACE	www.crmcwy.org	002-Medicare Only (PACE)	08	20		1			H4000	002	0	2015	002-Wyoming PACE		2		2			2								www.crmcwy.org	www.seniorscript.com									(000)000-0000		(307)634-2273		(000)000-0000		(307)634-2273										(800)877-9965		(800)877-9965		(800)877-9965		(800)877-9965												
H4003	009	0	1	01	01	H4003_009_0	8		1	08/02/2014	2015.01	08/02/2014 10:14:20 AM SA Western Standard Time	08/04/2014 06:19:00 PM SA Western Standard Time	08/04/2014 06:50:34 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - SUPREMO (HMO SNP)	01	01		1			H4003	009	0	2015	Puerto Rico		2		2			1	4		1		00000000000000000010		www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	015	0	1	01	01	H4003_015_0	8		1	08/02/2014	2015.01	08/02/2014 10:14:34 AM SA Western Standard Time	08/04/2014 06:27:20 PM SA Western Standard Time	08/04/2014 06:50:00 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - UNICO EXTRA (HMO)	01	01		1			H4003	015	0	2015	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	017	0	1	01	01	H4003_017_0	8	1	1	05/28/2014	2015.01	05/28/2014 07:57:05 PM SA Western Standard Time	08/04/2014 06:34:26 PM SA Western Standard Time	08/04/2014 06:51:38 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - DIAMANTE CHOICE (HMO SNP)	01	01		1			H4003	017	0	2015	Puerto Rico		2		2		1	1	3		1	3		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	018	0	1	01	01	H4003_018_0	6		1	05/28/2014	2015.01	05/28/2014 07:57:14 PM SA Western Standard Time	07/17/2014 02:29:02 PM SA Western Standard Time				07/23/2014 11:36:33 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - Original (HMO)	01	01		1			H4003	018	0	2015	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396										(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655										2					2					2
H4003	019	0	1	01	01	H4003_019_0	8		1	05/28/2014	2015.01	05/28/2014 07:57:22 PM SA Western Standard Time	08/04/2014 06:42:56 PM SA Western Standard Time	08/04/2014 06:52:36 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - Unico (HMO)	01	01		1			H4003	019	0	2015	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	021	0	1	01	01	H4003_021_0	8	1	1	05/28/2014	2015.01	05/28/2014 08:07:12 PM SA Western Standard Time	08/04/2014 06:38:36 PM SA Western Standard Time	08/04/2014 06:53:12 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - DIAMANTE EXTRA (HMO SNP)	01	01		1			H4003	021	0	2015	Puerto Rico		2	1500	2		1	1	3		1	3		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	027	0	1	02	01	H4003_027_0	9		1	08/02/2014	2015.01	08/02/2014 10:14:50 AM SA Western Standard Time	08/05/2014 10:41:54 AM SA Western Standard Time	08/04/2014 06:53:58 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - ELITE ULTRA (HMO-POS)	01	02		1			H4003	027	0	2015	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	029	0	1	02	01	H4003_029_0	9		1	08/02/2014	2015.01	08/02/2014 10:15:03 AM SA Western Standard Time	08/04/2014 06:40:38 PM SA Western Standard Time	08/04/2014 06:54:28 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	MEDICARE Y MUCHO MAS - ELITE SELECT (HMO-POS)	01	02		1			H4003	029	0	2015	PUERTO RICO		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	031	0	1	02	01	H4003_031_0	9		1	08/02/2014	2015.01	08/02/2014 10:16:05 AM SA Western Standard Time	08/06/2014 09:08:44 AM SA Western Standard Time	08/04/2014 06:55:06 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - ELITE PLUS (HMO-POS)	01	02		1			H4003	031	0	2015	Puerto Rico		2		2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	033	0	1	01	01	H4003_033_0	5	1	1	07/09/2014	2015.01	07/09/2014 10:44:20 AM SA Western Standard Time	08/04/2014 06:44:48 PM SA Western Standard Time	08/04/2014 06:55:40 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - DIAMANTE ULTRA PLATINO (HMO SNP)	01	01		1			H4003	033	0	2015	Puerto Rico		2		2		1	1	3		1	3		2	www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	803	0	1	02	01	H4003_803_0	5		1	05/28/2014	2015.01	05/28/2014 07:59:00 PM SA Western Standard Time	07/17/2014 03:17:58 PM SA Western Standard Time				07/23/2014 11:36:33 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - MAPD FLEX (HMO-POS)	01	02		1			H4003	803	0	2015	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	806	0	1	02	01	H4003_806_0	5		1	05/28/2014	2015.01	05/28/2014 07:50:33 PM SA Western Standard Time	07/17/2014 03:20:06 PM SA Western Standard Time				07/23/2014 11:36:33 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - MAPD Flex II (HMO-POS)	01	02		1			H4003	806	0	2015	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	807	0	1	02	01	H4003_807_0	5		1	05/28/2014	2015.01	05/28/2014 07:50:56 PM SA Western Standard Time	07/17/2014 03:23:08 PM SA Western Standard Time				07/23/2014 11:36:33 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - MAPD Flex III (HMO-POS)	01	02		1			H4003	807	0	2015	Puerto Rico		1	100	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4003	818	0	1	02	01	H4003_818_0	5		1	05/28/2014	2015.01	05/28/2014 07:51:17 PM SA Western Standard Time	07/17/2014 03:27:20 PM SA Western Standard Time				07/23/2014 11:36:33 AM SA Western Standard Time	MMM HEALTHCARE, INC.	Medicare y Mucho Ms	www.mmm-pr.com	Medicare y Mucho Mas - MAPD FLEX IV (HMO-POS) (HMO-POS)	01	02		1			H4003	818	0	2015	Puerto Rico		1	1500	2			2							www.mmm-pr.com	www.mmm-pr.com	www.mmm-pr.com	(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5470		(787)620-2397		(866)333-5471		(787)620-2396		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		(866)333-5469		(866)333-5469		(877)522-0655		(877)522-0655		2					2					2
H4004	015	0	1	02	01	H4004_015_0	9		1	08/02/2014	2015.01	08/02/2014 10:13:17 AM SA Western Standard Time	08/04/2014 06:45:40 PM SA Western Standard Time	08/04/2014 06:56:18 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	PREFERRED MEDICARE CHOICE, INC.	Preferred Medicare Choice, Inc.	www.pmcpr.org	Elite Dorado (HMO-POS)	01	02		1			H4004	015	0	2015	PUERTO RICO		2		2			2							www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		2					2					2
H4004	025	0	1	01	01	H4004_025_0	6		1	05/28/2014	2015.01	05/28/2014 07:59:20 PM SA Western Standard Time	07/20/2014 09:03:40 PM SA Western Standard Time				07/23/2014 11:36:33 AM SA Western Standard Time	PREFERRED MEDICARE CHOICE, INC.	Preferred Medicare Choice, Inc.	www.pmcpr.org	Dorado (HMO)	01	01		1			H4004	025	0	2015	PUERTO RICO		2		2			2							www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510										(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656										2					2					2
H4004	048	0	1	01	01	H4004_048_0	8	1	1	05/28/2014	2015.01	05/28/2014 07:59:29 PM SA Western Standard Time	08/04/2014 06:46:44 PM SA Western Standard Time	08/04/2014 06:57:00 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	PREFERRED MEDICARE CHOICE, INC.	Preferred Medicare Choice, Inc.	www.pmcpr.org	Premier Preferred (HMO SNP)	01	01		1			H4004	048	0	2015	PUERTO RICO		2		2		1	1	3		1	3		2	www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		2					2					2
H4004	050	0	1	01	01	H4004_050_0	9		1	08/02/2014	2015.01	08/02/2014 10:07:49 AM SA Western Standard Time	08/04/2014 06:47:50 PM SA Western Standard Time	08/04/2014 06:57:38 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	PREFERRED MEDICARE CHOICE, INC.	Preferred Medicare Choice, Inc.	www.pmcpr.org	PMC Max (HMO)	01	01		1			H4004	050	0	2015	PUERTO RICO		2		2			2							www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		2					2					2
H4004	053	0	1	02	01	H4004_053_0	9		1	08/02/2014	2015.01	08/02/2014 03:41:45 PM SA Western Standard Time	08/04/2014 06:48:52 PM SA Western Standard Time	08/04/2014 06:58:20 PM SA Western Standard Time			08/06/2014 09:10:31 AM SA Western Standard Time	PREFERRED MEDICARE CHOICE, INC.	Preferred Medicare Choice, Inc.	www.pmcpr.org	PMC Max - EXTRA (HMO-POS)	01	02		1			H4004	053	0	2015	PUERTO RICO		2		2			2							www.pmcpr.org	www.pmcpr.org	www.pmcpr.org	(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7700		(787)625-2126		(877)568-0808		(787)622-7510		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		(866)516-7701		(866)516-7701		(877)522-0656		(877)522-0656		2					2					2
H4005	001	0	1	04	01	H4005_001_0	8		1	07/17/2014	2015.01	07/17/2014 10:19:58 PM SA Western Standard Time	07/16/2014 09:22:32 PM SA Western Standard Time				07/20/2014 08:07:42 PM SA Western Standard Time	TRIPLE-S SALUD, INC.	Triple-S Salud, Inc.	www.sssplanesmedicare.com	ptimo (PPO)	01	04		1			H4005	001	0	2015	Island of Puerto Rico		2	635	2			2							http://www.ssspr.com/SSSPortal/ProviderSearch.aspx	www.sssplanesmedicare.com	www.sssplanesmedicare.com	(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777										(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059										2					2					
H4005	004	0	1	04	01	H4005_004_0	10		1	07/17/2014	2015.01	07/17/2014 10:19:26 PM SA Western Standard Time	08/06/2014 04:55:44 PM SA Western Standard Time	08/01/2014 09:10:34 AM SA Western Standard Time			08/06/2014 06:37:32 PM SA Western Standard Time	TRIPLE-S SALUD, INC.	Triple-S Salud, Inc.	www.sssplanesmedicare.com	ptimo Plus (PPO)	01	04		1			H4005	004	0	2015	Island of Puerto Rico		2	9001	2			2							http://www.ssspr.com/SSSPortal/ProviderSearch.aspx	www.sssplanesmedicare.com	www.sssplanesmedicare.com	(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		2					2					
H4005	801	0	1	04	01	H4005_801_0	7		1	06/02/2014	2015.01	06/02/2014 01:39:17 AM SA Western Standard Time	07/16/2014 09:22:44 PM SA Western Standard Time				07/16/2014 09:33:08 PM SA Western Standard Time	TRIPLE-S SALUD, INC.	Triple-S Salud, Inc.	www.sssplanesmedicare.com	ptimo (PPO)	01	04		1			H4005	801	0	2015	Island of Puerto Rico		1	99	2			2							http://www.ssspr.com/SSSPortal/ProviderSearch.aspx	www.sssplanesmedicare.com	www.sssplanesmedicare.com	(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777										(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059										2					2					
H4005	802	0	1	04	01	H4005_802_0	6		1	06/02/2014	2015.01	06/02/2014 04:09:12 PM SA Western Standard Time	07/16/2014 09:21:53 PM SA Western Standard Time				07/16/2014 09:33:08 PM SA Western Standard Time	TRIPLE-S SALUD, INC.	Triple-S Salud, Inc.	www.sssplanesmedicare.com	ptimo Plus A (PPO)	01	04		1			H4005	802	0	2015	Island of Puerto Rico		1	13173	2			2							http://www.ssspr.com/SSSPortal/ProviderSearch.aspx	www.sssplanesmedicare.com	www.sssplanesmedicare.com	(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		2					2					
H4005	804	0	1	04	01	H4005_804_0	6		1	06/02/2014	2015.01	06/02/2014 01:40:34 AM SA Western Standard Time	07/16/2014 09:22:01 PM SA Western Standard Time				07/16/2014 09:33:08 PM SA Western Standard Time	TRIPLE-S SALUD, INC.	Triple-S Salud, Inc.	www.sssplanesmedicare.com	ptimo Plus B (PPO)	01	04		1			H4005	804	0	2015	Island of Puerto Rico		1	175	2			2							http://www.ssspr.com/SSSPortal/ProviderSearch.aspx	www.sssplanesmedicare.com	www.sssplanesmedicare.com	(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		2					2					
H4005	807	0	1	04	01	H4005_807_0	6		1	06/02/2014	2015.01	06/02/2014 01:41:01 AM SA Western Standard Time	07/16/2014 09:22:08 PM SA Western Standard Time				07/16/2014 09:33:08 PM SA Western Standard Time	TRIPLE-S SALUD, INC.	Triple-S Salud, Inc.	www.sssplanesmedicare.com	ptimo Plus C (PPO)	01	04		1			H4005	807	0	2015	Island of Puerto Rico		1	99	2			2							http://www.ssspr.com/SSSPortal/ProviderSearch.aspx	www.sssplanesmedicare.com	www.sssplanesmedicare.com	(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)510-0722		(787)774-6083		(877)207-8777		(877)207-8777		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		(800)383-4457		(787)749-4059		2					2					
H4007	005	0	1	01	01	H4007_005_0	8	1	1	07/11/2014	2015.02	07/11/2014 09:39:16 AM Eastern Daylight Time	08/05/2014 09:37:19 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:10:38 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4007-005 (HMO SNP)	01	01		1			H4007	005	0	2015	Puerto Rico Island Wide		2		2		1	1	3		1	3		2		www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4007	012	0	1	01	01	H4007_012_0	6		1	08/02/2014	2015.02	08/02/2014 10:06:12 AM Eastern Daylight Time	08/05/2014 09:39:28 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:10:38 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus H4007-012 (HMO)	01	01		1			H4007	012	0	2015	Puerto Rico Island Wide		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4007	013	0	1	01	01	H4007_013_0	7		1	08/13/2014	2015.02	08/13/2014 03:42:54 PM Eastern Daylight Time	08/14/2014 02:21:36 PM Eastern Daylight Time	08/14/2014 08:16:11 AM Eastern Daylight Time			08/14/2014 02:37:31 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus H4007-013 (HMO)	01	01		1			H4007	013	0	2015	Puerto Rico Island Wide		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4007	016	0	1	01	01	H4007_016_0	4	1	1	07/11/2014	2015.02	07/11/2014 09:40:17 AM Eastern Daylight Time	08/05/2014 09:45:09 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 09:10:38 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4007-016 (HMO SNP)	01	01		1			H4007	016	0	2015	Puerto Rico Island Wide		2		2		1	1	3		1	3		2		www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4007	801	0	1	01	01	H4007_801_0	3		1	05/23/2014	2015.02	05/23/2014 02:44:31 PM Eastern Daylight Time	08/04/2014 11:06:26 PM Eastern Daylight Time				08/06/2014 11:00:52 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	801	0	2015	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4007	802	0	1	01	01	H4007_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:45:13 PM Eastern Daylight Time	08/04/2014 11:07:14 PM Eastern Daylight Time				08/06/2014 11:00:52 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	802	0	2015	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4007	805	0	1	01	01	H4007_805_0	2		1	05/23/2014	2015.02	05/23/2014 02:45:54 PM Eastern Daylight Time	07/14/2014 11:01:47 AM Eastern Daylight Time				07/14/2014 01:58:48 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	805	0	2015	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4007	806	0	1	01	01	H4007_806_0	3		1	05/23/2014	2015.02	05/23/2014 02:46:36 PM Eastern Daylight Time	08/04/2014 11:08:37 PM Eastern Daylight Time				08/06/2014 11:00:52 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	806	0	2015	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4007	808	0	1	01	01	H4007_808_0	2		1	05/23/2014	2015.02	05/23/2014 02:47:17 PM Eastern Daylight Time	07/14/2014 11:12:25 AM Eastern Daylight Time				07/14/2014 01:58:48 PM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	808	0	2015	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4007	809	0	1	01	01	H4007_809_0	3		1	05/23/2014	2015.02	05/23/2014 02:47:58 PM Eastern Daylight Time	08/04/2014 11:10:03 PM Eastern Daylight Time				08/06/2014 11:00:52 AM Eastern Daylight Time	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4007	809	0	2015	Puerto Rico - Island Wide		1		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4011	001	0	1	04	01	H4011_001_0	9		1	06/02/2014	2015.01	06/02/2014 08:27:52 PM SA Western Standard Time	07/22/2014 12:01:52 PM SA Western Standard Time				07/22/2014 04:59:19 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First+Plus Advantage (PPO)	01	04		1			H4011	001	0	2015	Entire Island Puerto Rico		2		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242										(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242										2					2					
H4011	003	0	1	04	01	H4011_003_0	11		1	08/05/2014	2015.01	08/05/2014 03:49:08 PM SA Western Standard Time	08/02/2014 10:02:30 AM SA Western Standard Time	08/04/2014 03:19:10 PM SA Western Standard Time			08/05/2014 03:55:25 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First+Plus Advantage Plus (PPO)	01	04		1			H4011	003	0	2015	Enitre Island Puerto Rico		2		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		2					2					
H4011	801	0	1	04	01	H4011_801_0	8		1	06/02/2014	2015.01	06/02/2014 04:58:06 PM SA Western Standard Time	07/03/2014 03:01:54 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 1 (PPO)	01	04		1			H4011	801	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	803	0	1	04	01	H4011_803_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:06 PM SA Western Standard Time	07/03/2014 03:02:12 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 3 (PPO)	01	04		1			H4011	803	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	805	0	1	04	01	H4011_805_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:08 PM SA Western Standard Time	07/03/2014 03:02:28 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 5 (PPO)	01	04		1			H4011	805	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	807	0	1	04	01	H4011_807_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:09 PM SA Western Standard Time	07/03/2014 03:02:46 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 7 (PPO)	01	04		1			H4011	807	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	809	0	1	04	01	H4011_809_0	8		1	06/02/2014	2015.01	06/02/2014 04:58:24 PM SA Western Standard Time	07/03/2014 03:03:04 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 9 (PPO)	01	04		1			H4011	809	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	811	0	1	04	01	H4011_811_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:12 PM SA Western Standard Time	07/03/2014 03:03:20 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 11 (PPO)	01	04		1			H4011	811	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	813	0	1	04	01	H4011_813_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:14 PM SA Western Standard Time	07/03/2014 03:03:38 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 13 (PPO)	01	04		1			H4011	813	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	815	0	1	04	01	H4011_815_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:16 PM SA Western Standard Time	07/03/2014 03:03:54 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 15 (PPO)	01	04		1			H4011	815	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	817	0	1	04	01	H4011_817_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:17 PM SA Western Standard Time	07/03/2014 03:04:14 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 17 (PPO)	01	04		1			H4011	817	0	2015	Entire Island Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	820	0	1	04	01	H4011_820_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:19 PM SA Western Standard Time	07/03/2014 03:04:32 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 20 (PPO)	01	04		1			H4011	820	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	821	0	1	04	01	H4011_821_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:21 PM SA Western Standard Time	07/03/2014 03:04:48 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 21 (PPO)	01	04		1			H4011	821	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	822	0	1	04	01	H4011_822_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:23 PM SA Western Standard Time	07/03/2014 03:05:06 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 22 (PPO)	01	04		1			H4011	822	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	823	0	1	04	01	H4011_823_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:25 PM SA Western Standard Time	07/03/2014 03:05:24 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 23 (PPO)	01	04		1			H4011	823	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	824	0	1	04	01	H4011_824_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:27 PM SA Western Standard Time	07/03/2014 03:05:42 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 24 (PPO)	01	04		1			H4011	824	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4011	825	0	1	04	01	H4011_825_0	8		1	06/02/2014	2015.01	06/02/2014 04:49:28 PM SA Western Standard Time	07/03/2014 03:06:00 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 25 (PPO)	01	04		1			H4011	825	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					
H4036	008	0	1	04	01	H4036_008_0	12		1	07/18/2014	2015.01	07/18/2014 12:44:00 PM Central Daylight Time	08/06/2014 02:52:27 AM Eastern Daylight Time	08/01/2014 05:31:05 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Core (PPO)	01	04		1			H4036	008	0	2015	East and Southeast Wisconsin		2	369	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4036	009	0	1	04	01	H4036_009_0	12		1	07/18/2014	2015.01	07/18/2014 12:44:14 PM Central Daylight Time	08/06/2014 02:52:32 AM Eastern Daylight Time	08/01/2014 05:31:06 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H4036	009	0	2015	Central Wisconsin		2	131	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4036	801	0	1	04	01	H4036_801_0	5		1	05/30/2014	2015.01	05/30/2014 03:09:43 PM Pacific Daylight Time	07/15/2014 03:53:19 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	801	0	2015	Wisconsin		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H4036	802	0	1	04	01	H4036_802_0	5		1	05/30/2014	2015.01	05/30/2014 03:09:46 PM Pacific Daylight Time	07/15/2014 03:53:31 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	802	0	2015	Wisconsin		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H4036	803	0	1	04	01	H4036_803_0	5		1	05/30/2014	2015.01	05/30/2014 03:09:49 PM Pacific Daylight Time	07/15/2014 03:53:45 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4036	803	0	2015	Wisconsin		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H4074	001	0	1	20	08	H4074_001_0	1		1	05/27/2014	2015.01	05/27/2014 08:21:35 AM Central Daylight Time		05/19/2014 06:33:12 PM Central Daylight Time			05/27/2014 08:28:21 AM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	001	0	2015	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2								www.mercylifeal.com	www.mercylifeal.com									(251)287-2842		(251)287-8420		(251)287-8420		(251)287-8420										(251)287-8420		(251)287-8420		(251)287-8420		(251)287-8420												
H4074	002	0	1	20	08	H4074_002_0	1		1	05/20/2014	2015.01	05/20/2014 03:27:15 PM Central Daylight Time		05/19/2014 06:43:06 PM Central Daylight Time			05/27/2014 08:28:21 AM Central Daylight Time	MERCY LIFE OF ALABAMA	Mercy LIFE of Alabama	mercylifeal.com	Mercy LIFE of Alabama (PACE)	08	20		1			H4074	002	0	2015	Mercy LIFE of Alabama Baldwin and Mobile counties		2		2			2								www.mercylifeal.com	www.mercylifeal.com									(251)287-2842		(251)287-8420		(251)287-8420		(251)287-8420										(251)287-8420		(251)287-8420		(251)287-8420		(251)287-8420												
H4102	001	0	1	01	01	H4102_001_0	2		1	05/30/2014	2015.01	05/30/2014 04:36:43 PM Central Daylight Time	08/04/2014 03:30:35 PM Central Daylight Time	07/31/2014 03:18:12 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4102	001	0	2015	All counties in Rhode Island		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4102	025	0	1	01	01	H4102_025_0	1		1	05/29/2014	2015.01	05/29/2014 08:36:26 AM Central Daylight Time	05/30/2014 05:50:19 PM Central Daylight Time				05/31/2014 10:35:20 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H4102	025	0	2015	All counties in Rhode Island		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H4102	030	0	1	01	01	H4102_030_0	2		1	05/30/2014	2015.01	05/30/2014 04:37:00 PM Central Daylight Time	08/04/2014 03:31:00 PM Central Daylight Time	07/31/2014 03:18:15 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4102	030	0	2015	Berks and Bucks counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4102	031	0	1	01	01	H4102_031_0	2		1	05/30/2014	2015.01	05/30/2014 04:37:18 PM Central Daylight Time	08/04/2014 03:31:33 PM Central Daylight Time	07/31/2014 03:18:18 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4102	031	0	2015	Washington and Windham counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4102	032	0	1	01	01	H4102_032_0	2		1	05/30/2014	2015.01	05/30/2014 04:37:32 PM Central Daylight Time	08/04/2014 03:31:59 PM Central Daylight Time	07/31/2014 03:18:22 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4102	032	0	2015	Rhode Island		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4102	033	0	1	01	01	H4102_033_0	2		1	05/30/2014	2015.01	05/30/2014 04:37:57 PM Central Daylight Time	08/04/2014 03:32:32 PM Central Daylight Time	07/31/2014 03:18:25 PM Central Daylight Time			08/06/2014 09:56:00 AM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4102	033	0	2015	Bristol county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4102	801	0	1	01	01	H4102_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:13:57 AM Central Daylight Time	05/30/2014 05:52:15 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4102	801	0	2015	State of Rhode Island		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4102	802	0	1	01	01	H4102_802_0	1		1	05/22/2014	2015.01	05/22/2014 09:14:07 AM Central Daylight Time	05/30/2014 05:52:39 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4102	802	0	2015	Rhode Island		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H4102	803	0	1	01	01	H4102_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:14:21 AM Central Daylight Time	05/30/2014 05:53:03 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4102	803	0	2015	Select counties in RI		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4105	001	0	1	20	08	H4105_001_0	1		1	05/19/2014	2015.01	05/19/2014 04:29:23 PM Eastern Daylight Time		05/16/2014 02:23:46 PM Eastern Daylight Time			05/19/2014 04:31:39 PM Eastern Daylight Time	PACE ORGANIZATION OF RHODE ISLAND	Pace Organization Of Rhode Island	www.pace-ri.org	PACE Organization of Rhode Island (PACE)	08	20		1			H4105	001	0	2015	PACE Organization of Rhode Island		2		2			2								www.pace-ri.org	www.pace-ri.org									(877)781-7223		(401)490-6566		(877)781-7223		(401)490-6566										(866)883-1631		(401)490-4597		(866)883-1631		(401)490-4597												
H4105	002	0	1	20	08	H4105_002_0	1		1	05/19/2014	2015.01	05/19/2014 04:09:40 PM Eastern Daylight Time		05/16/2014 02:43:57 PM Eastern Daylight Time			05/19/2014 04:31:39 PM Eastern Daylight Time	PACE ORGANIZATION OF RHODE ISLAND	Pace Organization Of Rhode Island	www.pace-ri.org	PACE Organization of Rhode Island (PACE)	08	20		1			H4105	002	0	2015	PACE Organization of Rhode Island		2		2			2								www.pace-ri.org	www.pace-ri.org									(877)781-7223		(401)490-6566		(877)781-7223		(401)490-6566										(866)883-1631		(401)490-4597		(866)883-1631		(401)490-4597												
H4118	001	0	1	20	08	H4118_001_0	1		1	05/21/2014	2015.01	05/21/2014 01:13:42 PM Eastern Daylight Time		05/21/2014 01:15:53 PM Eastern Daylight Time			05/23/2014 10:44:05 AM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.hvpace.org	Huron Valley PACE - Dual Eligible (PACE)	08	20		1			H4118	001	0	2015	The Washtenaw PACE Inc.		2		2			2								www.hvpace.org	www.kltcpharmacy.com									(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777												
H4118	002	0	1	20	08	H4118_002_0	1		1	05/21/2014	2015.01	05/21/2014 01:15:14 PM Eastern Daylight Time		05/21/2014 01:15:53 PM Eastern Daylight Time			05/23/2014 10:44:05 AM Eastern Daylight Time	THE WASHTENAW PACE	Huron Valley PACE	www.hvpace.org	Huron Valley PACE - Medicare Only (PACE)	08	20		1			H4118	002	0	2015	The Washtenaw PACE Inc.		2		2			2								www.hvpace.org	www.kltcpharmacy.com									(855)483-7223		(734)572-5777		(855)483-7223		(734)572-5777										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777												
H4141	001	0	1	01	01	H4141_001_0	6		1	08/11/2014	2015.02	08/11/2014 01:32:13 PM Eastern Daylight Time	08/07/2014 03:45:04 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/11/2014 04:16:48 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-001 (HMO)	01	01		1			H4141	001	0	2015	Atlanta Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	003	0	1	01	01	H4141_003_0	5	2	1	08/02/2014	2015.02	08/02/2014 03:55:22 PM Eastern Daylight Time	08/05/2014 09:37:57 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4141-003 (HMO SNP)	01	01		1			H4141	003	0	2015	Atlanta Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	004	0	1	01	01	H4141_004_0	6		1	08/02/2014	2015.02	08/02/2014 05:02:50 PM Eastern Daylight Time	08/05/2014 09:40:02 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-004 (HMO)	01	01		1			H4141	004	0	2015	Burke, Columbia, McDuffie and Richmond counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	008	0	1	01	01	H4141_008_0	5		1	07/10/2014	2015.02	07/10/2014 05:32:46 PM Eastern Daylight Time	08/05/2014 09:38:31 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-008 (HMO)	01	01		1			H4141	008	0	2015	Catoosa, Dade and Walker counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	009	0	1	01	01	H4141_009_0	5		1	08/02/2014	2015.02	08/02/2014 05:07:36 PM Eastern Daylight Time	08/05/2014 09:38:49 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H4141-009 (HMO SNP)	01	01		1			H4141	009	0	2015	Atlanta Metro Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	010	0	1	01	01	H4141_010_0	8	2	1	08/02/2014	2015.02	08/02/2014 05:12:39 PM Eastern Daylight Time	08/05/2014 09:39:42 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4141-010 (HMO SNP)	01	01		1			H4141	010	0	2015	Athens Metro Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	011	0	1	01	01	H4141_011_0	5		1	08/02/2014	2015.02	08/02/2014 04:00:12 PM Eastern Daylight Time	08/05/2014 09:39:23 AM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 12:25:38 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Gold Plus H4141-011 (HMO)	01	01		1			H4141	011	0	2015	Columbus Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4141	801	0	1	01	01	H4141_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:48:39 PM Eastern Daylight Time	07/14/2014 10:47:03 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4141	801	0	2015	Select counties in Georgia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4141	802	0	1	01	01	H4141_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:49:20 PM Eastern Daylight Time	07/14/2014 10:49:10 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Humana Employers Health Plan of Georgia, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4141	802	0	2015	Select counties in Georgia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4142	001	0	1	20	08	H4142_001_0	1		1	05/19/2014	2015.01	05/19/2014 10:25:23 AM Central Daylight Time		05/16/2014 03:42:33 PM Central Daylight Time			05/19/2014 10:27:26 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	08	20		1			H4142	001	0	2015	Cherokee and surrounding counties		2		2			2								eldercare.cherokee.org	eldercare.cherokee.org									(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554												
H4142	002	0	1	20	08	H4142_002_0	1		1	05/19/2014	2015.01	05/19/2014 10:26:01 AM Central Daylight Time		05/16/2014 03:48:34 PM Central Daylight Time			05/19/2014 10:27:26 AM Central Daylight Time	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	Cherokee Elder Care	http://eldercare.cherokee.org	Cherokee Elder Care (PACE)	08	20		1			H4142	002	0	2015	Cherokee and surrounding counties		2		2			2								eldercare.cherokee.org	eldercare.cherokee.org									(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554										(800)256-0671	5554	(918)453-5554		(800)256-0671	5554	(918)453-5554												
H4145	001	0	1	01	01	H4145_001_0	3		1	07/10/2014	2015.01	07/10/2014 01:54:46 PM Eastern Daylight Time	08/04/2014 05:04:10 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H4145-001 (HMO)	01	01		1			H4145	001	0	2015	Canadian, Cleveland and Oklahoma counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4145	002	0	1	01	01	H4145_002_0	3		1	07/10/2014	2015.01	07/10/2014 01:54:14 PM Eastern Daylight Time	08/04/2014 05:07:28 PM Eastern Daylight Time	08/04/2014 05:04:13 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H4145-002 (HMO)	01	01		1			H4145	002	0	2015	Okmulgee and Tulsa counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4145	801	0	1	01	01	H4145_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:50:01 PM Eastern Daylight Time	07/14/2014 11:15:53 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4145	801	0	2015	Select Counties in Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4145	802	0	1	01	01	H4145_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:50:41 PM Eastern Daylight Time	07/14/2014 11:16:24 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA REGIONAL HEALTH PLAN, INC.	Humana Regional Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4145	802	0	2015	Select Counties in Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4152	004	0	1	01	01	H4152_004_0	9		1	07/24/2014	2015.01	07/24/2014 01:26:57 PM Eastern Daylight Time	07/08/2014 03:20:15 PM Eastern Daylight Time				07/25/2014 10:13:12 AM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Core (HMO)	01	01		1			H4152	004	0	2015	State of Rhode Island		2	952	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583										(711)-		(711)-		(711)-		(711)-										2					2					2
H4152	005	0	1	01	01	H4152_005_0	11		1	07/24/2014	2015.01	07/24/2014 01:32:52 PM Eastern Daylight Time	08/06/2014 02:14:08 PM Eastern Daylight Time	08/01/2014 02:57:34 PM Eastern Daylight Time			08/06/2014 08:11:13 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Plus (HMO)	01	01		1			H4152	005	0	2015	State of Rhode Island		2	4011	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4152	007	0	1	02	01	H4152_007_0	11		1	07/24/2014	2015.01	07/24/2014 01:36:38 PM Eastern Daylight Time	08/06/2014 02:21:38 PM Eastern Daylight Time	08/01/2014 03:02:34 PM Eastern Daylight Time			08/06/2014 08:11:13 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Preferred (HMO-POS)	01	02		1			H4152	007	0	2015	State of Rhode Island		2	1952	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4152	013	0	1	01	01	H4152_013_0	10		1	08/06/2014	2015.01	08/06/2014 03:12:22 PM Eastern Daylight Time	08/06/2014 06:51:54 PM Eastern Daylight Time	08/01/2014 03:05:42 PM Eastern Daylight Time			08/06/2014 08:11:13 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Standard with Drugs (HMO)	01	01		1			H4152	013	0	2015	State of Rhode Island		2	8080	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4152	016	0	1	02	01	H4152_016_0	10		1	08/06/2014	2015.01	08/06/2014 03:07:00 PM Eastern Daylight Time	08/06/2014 07:04:33 PM Eastern Daylight Time	08/01/2014 03:10:58 PM Eastern Daylight Time			08/06/2014 08:11:13 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Value (HMO-POS)	01	02		1			H4152	016	0	2015	State of Rhode Island		2	27586	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4152	017	0	1	01	01	H4152_017_0	9		1	08/06/2014	2015.01	08/06/2014 03:53:41 PM Eastern Daylight Time	08/06/2014 04:34:41 PM Eastern Daylight Time	08/01/2014 03:15:22 PM Eastern Daylight Time			08/06/2014 08:11:13 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Select (HMO)	01	01		1			H4152	017	0	2015	State of Rhode Island		2	2000	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4152	018	0	1	02	01	H4152_018_0	10		1	07/24/2014	2015.01	07/24/2014 01:52:58 PM Eastern Daylight Time	08/06/2014 04:22:03 PM Eastern Daylight Time	08/01/2014 03:18:55 PM Eastern Daylight Time			08/06/2014 08:11:13 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.BCBSRI.com/Medicare	BlueCHiP for Medicare Extra (HMO-POS)	01	02		1			H4152	018	0	2015	State of Rhode Island		2	800	2			2							http://findadoctor.bcbsri.com/	www.BCBSRI.com/Medicare	www.BCBSRI.com/Medicare	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4152	815	0	1	02	01	H4152_815_0	4		1	06/09/2014	2015.01	06/09/2014 07:46:03 PM Eastern Daylight Time	06/09/2014 03:07:46 PM Eastern Daylight Time				06/09/2014 07:56:33 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.bcbsri.com	BlueCHiP for Medicare Group Preferred (HMO-POS)	01	02		1			H4152	815	0	2015	RI, Bristol Cty MA, Partial New London Cty CT		1	2180	2			2							http://findadoctor.bcbsri.com/	www.bcbsri.com	www.bcbsri.com	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111110111111111111111110000100	2		1	1	011111111110111111111111111110000100	2		1
H4152	817	0	1	01	01	H4152_817_0	4		1	06/09/2014	2015.01	06/09/2014 07:45:52 PM Eastern Daylight Time	06/09/2014 02:46:33 PM Eastern Daylight Time				06/09/2014 07:56:33 PM Eastern Daylight Time	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Blue Cross & Blue Shield of Rhode Island	www.bcbsri.com	BlueCHiP for Medicare Group Plus (HMO)	01	01		1			H4152	817	0	2015	RI, Bristol Cty MA, Partial New London Cty CT		1	588	2			2							http://findadoctor.bcbsri.com/	www.bcbsri.com	www.bcbsri.com	(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(800)267-0439		(401)277-2958		(800)505-2583		(401)351-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111110111111111111111110000100	2		1					1
H4199	001	0	1	01	01	H4199_001_0	6		1	09/24/2014	2015.02	09/24/2014 12:58:05 PM Central Daylight Time	08/06/2014 04:43:13 PM Central Daylight Time	08/05/2014 03:53:25 PM Central Daylight Time			09/24/2014 08:26:49 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunrise (HMO)	01	01		1			H4199	001	0	2015	Miami-Dade		2	500	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	002	0	1	01	01	H4199_002_0	7		1	09/24/2014	2015.02	09/24/2014 12:59:56 PM Central Daylight Time	08/06/2014 04:43:56 PM Central Daylight Time	08/05/2014 03:53:38 PM Central Daylight Time			09/24/2014 08:26:49 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Day Break (HMO)	01	01		1			H4199	002	0	2015	Miami-Dade		2	375	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	005	0	1	01	01	H4199_005_0	6		1	09/24/2014	2015.02	09/24/2014 01:00:54 PM Central Daylight Time	08/06/2014 04:45:02 PM Central Daylight Time	08/05/2014 03:58:09 PM Central Daylight Time			09/24/2014 08:26:49 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Clear Skies (HMO SNP)	01	01		1			H4199	005	0	2015	Miami-Dade		2	1000	2			1	4		1		00000000000000000010		www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	006	0	1	01	01	H4199_006_0	6	2	1	09/24/2014	2015.02	09/24/2014 01:01:40 PM Central Daylight Time	08/06/2014 04:46:37 PM Central Daylight Time	08/05/2014 03:57:54 PM Central Daylight Time			09/24/2014 08:26:49 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunny Days (HMO SNP)	01	01		1			H4199	006	0	2015	Miami-Dade		2	1000	2			1	3		1	4			www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	007	0	1	01	01	H4199_007_0	6		1	09/24/2014	2015.02	09/24/2014 09:23:29 PM Central Daylight Time	08/06/2014 04:47:37 PM Central Daylight Time	08/05/2014 03:57:40 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunrise (HMO)	01	01		1			H4199	007	0	2015	Orlando Region and Duval		2	6000	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	008	0	1	01	01	H4199_008_0	6		1	09/24/2014	2015.02	09/24/2014 09:37:11 PM Central Daylight Time	08/06/2014 04:49:25 PM Central Daylight Time	08/05/2014 03:57:25 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Day Break (HMO)	01	01		1			H4199	008	0	2015	Orlando region and Duval		2	1000	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	010	0	1	01	01	H4199_010_0	7		1	09/24/2014	2015.02	09/24/2014 09:37:38 PM Central Daylight Time	08/06/2014 04:50:19 PM Central Daylight Time	08/05/2014 03:57:11 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Clear Skies (HMO SNP)	01	01		1			H4199	010	0	2015	Brevard, Orange, Seminole and Volusia Counties		2	1000	2			1	4		1		00000000000000000010		www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	011	0	1	01	01	H4199_011_0	6	2	1	09/24/2014	2015.02	09/24/2014 09:37:38 PM Central Daylight Time	08/06/2014 04:53:40 PM Central Daylight Time	08/05/2014 03:56:57 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunny Days (HMO SNP)	01	01		1			H4199	011	0	2015	Brevard, Orange, Seminole and Volusia Counties		2	1000	2			1	3		1	4			www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	012	0	1	01	01	H4199_012_0	6		1	09/24/2014	2015.02	09/24/2014 09:37:39 PM Central Daylight Time	08/06/2014 04:54:21 PM Central Daylight Time	08/05/2014 03:56:42 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunrise (HMO)	01	01		1			H4199	012	0	2015	Broward, St Lucie and Palm Beach Counties		2	6000	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	013	0	1	01	01	H4199_013_0	6		1	09/24/2014	2015.02	09/24/2014 09:37:39 PM Central Daylight Time	08/06/2014 04:55:00 PM Central Daylight Time	08/05/2014 03:56:28 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Day Break (HMO)	01	01		1			H4199	013	0	2015	Broward, St Lucie and Palm Beach Counties		2	1000	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	015	0	1	01	01	H4199_015_0	7		1	09/24/2014	2015.02	09/24/2014 09:37:39 PM Central Daylight Time	08/06/2014 04:56:43 PM Central Daylight Time	08/05/2014 03:56:13 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Clear Skies (HMO SNP)	01	01		1			H4199	015	0	2015	Broward and Palm Beach Counties		2	1000	2			1	4		1		00000000000000000010		www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	016	0	1	01	01	H4199_016_0	6	2	1	09/24/2014	2015.02	09/24/2014 09:47:29 PM Central Daylight Time	08/06/2014 04:57:23 PM Central Daylight Time	08/05/2014 03:55:57 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunny Days (HMO SNP)	01	01		1			H4199	016	0	2015	Broward and Palm Beach Counties		2	1000	2			1	3		1	4			www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	017	0	1	01	01	H4199_017_0	6		1	09/24/2014	2015.02	09/24/2014 09:37:40 PM Central Daylight Time	08/06/2014 05:01:40 PM Central Daylight Time	08/05/2014 04:12:52 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunrise (HMO)	01	01		1			H4199	017	0	2015	Tampa Bay Region		2	6000	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	018	0	1	01	01	H4199_018_0	6		1	09/24/2014	2015.02	09/24/2014 09:47:48 PM Central Daylight Time	08/06/2014 05:02:46 PM Central Daylight Time	08/05/2014 04:12:39 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Day Break (HMO)	01	01		1			H4199	018	0	2015	Tampa Bay Region		2	1000	2			2							www.floridahealthcareplus.com	www.FloridaHealthCarePlus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	020	0	1	01	01	H4199_020_0	7		1	09/24/2014	2015.02	09/24/2014 09:37:40 PM Central Daylight Time	08/06/2014 05:04:54 PM Central Daylight Time	08/05/2014 03:55:10 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Clear Skies (HMO SNP)	01	01		1			H4199	020	0	2015	Hillsborough, Pinellas, Polk and Pasco Counties		2	1000	2			1	4		1		00000000000000000010		www.floridahealthcareplus.com	www.floridahealthcareplus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4199	021	0	1	01	01	H4199_021_0	6	2	1	09/24/2014	2015.02	09/24/2014 09:37:40 PM Central Daylight Time	08/06/2014 05:05:37 PM Central Daylight Time	08/05/2014 03:58:27 PM Central Daylight Time			09/24/2014 10:03:06 PM Central Daylight Time	FLORIDA HEALTHCARE PLUS, INC.	FLORIDA HEALTHCARE PLUS	www.FloridaHealthCarePlus.com	Sunny Days (HMO SNP)	01	01		1			H4199	021	0	2015	Hillsborough, Pinellas, Polk and Pasco Counties		2	1000	2			1	3		1	4			www.floridahealthcareplus.com	www.floridahealthcareplus.com	www.floridahealthcareplus.com	(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(866)988-2210		(305)888-2210		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H4203	001	0	1	20	08	H4203_001_0	1		1	05/19/2014	2015.01	05/19/2014 02:21:22 PM Eastern Daylight Time		05/17/2014 11:28:59 AM Eastern Daylight Time			05/20/2014 07:09:31 AM Eastern Daylight Time	PALMETTO HEALTH ALLIANCE	Palmetto SeniorCare	www.palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	08	20		1			H4203	001	0	2015	Richland and  Lexington Counties		2		2			2								n/a	N/A									(803)931-8175		(803)931-8175		(803)931-8175		(803)931-8175										(803)434-7000		(803)434-7000		(803)434-7000		(803)434-7000												
H4203	002	0	1	20	08	H4203_002_0	1		1	05/19/2014	2015.01	05/19/2014 02:27:03 PM Eastern Daylight Time		05/17/2014 11:35:09 AM Eastern Daylight Time			05/20/2014 07:09:31 AM Eastern Daylight Time	PALMETTO HEALTH ALLIANCE	Palmetto SeniorCare	www.palmettohealth.org	Palmetto Health - Palmetto SeniorCare (PACE)	08	20		1			H4203	002	0	2015	Richland and Lexington Counties		2		2			2								n/a	N/A									(803)931-8175		(803)931-8175		(803)931-8175		(803)931-8175	245									(803)434-7000		(803)434-7000		(803)434-7000		(803)434-7000												
H4211	001	0	1	01	01	H4211_001_0	12	2	1	08/05/2014	2015.01	08/05/2014 09:09:13 AM Eastern Daylight Time	08/06/2014 02:20:57 PM Eastern Daylight Time	08/06/2014 04:05:13 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	AMGP GEORGIA MANAGED CARE COMPANY, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H4211	001	0	2015	Fulton / Chatham Counties		2	42	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4211	003	0	1	01	01	H4211_003_0	12		1	08/05/2014	2015.01	08/05/2014 10:04:15 AM Eastern Daylight Time	08/06/2014 02:21:22 PM Eastern Daylight Time	08/06/2014 04:05:18 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	AMGP GEORGIA MANAGED CARE COMPANY, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H4211	003	0	2015	Fulton / Chatham Counties		2	129	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4213	001	0	1	09	04	H4213_001_0	12		1	08/14/2014	2015.01	08/14/2014 03:42:48 PM Central Daylight Time	07/11/2014 10:27:38 AM Central Daylight Time				08/14/2014 03:47:21 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA (PFFS)	04	09	1	1			H4213	001	0	2015	Northwest, Some Eastern and Southern AR Counties		2	2600	2			2								www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869										2					2					2
H4213	002	0	1	09	04	H4213_002_0	11		1	08/14/2014	2015.01	08/14/2014 03:43:01 PM Central Daylight Time	07/11/2014 10:27:38 AM Central Daylight Time				08/14/2014 03:47:21 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage  MA (PFFS)	04	09	1	1			H4213	002	0	2015	Some Central, Southern and Eastern  AR Counties		2	3000	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869										2					2					2
H4213	004	0	1	09	04	H4213_004_0	15		1	08/14/2014	2015.01	08/14/2014 03:43:14 PM Central Daylight Time	08/08/2014 03:45:26 PM Central Daylight Time	08/01/2014 08:38:56 AM Central Daylight Time			08/14/2014 03:47:21 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA-PD Option 1 (PFFS)	04	09	1	1			H4213	004	0	2015	Northwest, Some Eastern, and Southern AR Counties		2	8197	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)242-5017		(888)242-5017		(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		2					2					2
H4213	005	0	1	09	04	H4213_005_0	13		1	08/14/2014	2015.01	08/14/2014 03:43:31 PM Central Daylight Time	08/01/2014 09:46:26 AM Central Daylight Time	08/01/2014 08:40:33 AM Central Daylight Time			08/14/2014 03:47:21 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Advantage MA-PD (PFFS)	04	09	1	1			H4213	005	0	2015	Some Central, Southern, and Eastern AR Counties		2	1230	2			2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)242-5017		(888)242-5017		(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		2					2					2
H4227	001	0	1	01	01	H4227_001_0	9	2	1	08/11/2014	2015.02	08/11/2014 05:51:48 PM Central Daylight Time	08/11/2014 10:27:29 AM Central Daylight Time	08/04/2014 10:32:44 AM Central Daylight Time			08/11/2014 06:55:09 PM Central Daylight Time	VISTA HEALTH PLAN, INC.	Vista Health Plan, Inc.	www.keystonevipchoice.com	Keystone VIP Choice (HMO SNP)	01	01		1			H4227	001	0	2015	Eastern Pennsylvania		2	2163	2			1	3		1	5			www.keystonevipchoice.com	www.keystonevipchoice.com	http://www.amerihealthmercy.com/	(800)450-1166		(800)450-1166		(855)241-3648		(855)241-3648		(866)828-0021		(866)828-0021		(855)241-3648		(855)241-3648		(866)428-7583		(866)428-7583		(855)241-3649		(855)241-3649		(711)-		(711)-		(855)241-3649		(855)241-3649		2					2					2
H4227	002	0	1	01	01	H4227_002_0	9	2	1	08/11/2014	2015.02	08/11/2014 05:52:12 PM Central Daylight Time	08/11/2014 10:27:29 AM Central Daylight Time	08/04/2014 10:32:28 AM Central Daylight Time			08/11/2014 06:55:09 PM Central Daylight Time	VISTA HEALTH PLAN, INC.	Vista Health Plan, Inc.	www.amerihealthvipcare.com	AmeriHealth VIP Care (HMO SNP)	01	01		1			H4227	002	0	2015	Eastern Pennsylvania		2	158	2			1	3		1	5			www.amerihealthvipcare.com	www.amerihealthvipcare.com	http://www.amerihealthmercy.com/	(866)533-5490		(866)533-5490		(855)241-3648		(855)241-3648		(866)429-8918		(866)429-8918		(855)241-3648		(855)241-3648		(866)428-7583		(866)428-7583		(855)241-3649		(855)241-3649		(711)-		(711)-		(855)241-3649		(855)241-3649		2					2					2
H4235	001	0	1	20	08	H4235_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:14:22 PM Eastern Daylight Time		05/20/2014 11:44:17 AM Eastern Daylight Time			05/28/2014 01:18:15 PM Eastern Daylight Time	SENIOR TOTAL LIFE CARE, INC.	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Dual (PACE)	08	20		1			H4235	001	0	2015	Gaston County and Parts of Cleveland and Lincoln		2		2			2								www.seniorTLC.org	www.seniortlc.org									(855)327-7852		(704)874-0600		(855)327-7852		(704)874-0600										(704)874-3307		(704)874-3307		(704)874-3307		(704)874-3307												
H4235	002	0	1	20	08	H4235_002_0	1		1	05/28/2014	2015.01	05/28/2014 01:15:17 PM Eastern Daylight Time		05/20/2014 11:54:23 AM Eastern Daylight Time			05/28/2014 01:18:15 PM Eastern Daylight Time	SENIOR TOTAL LIFE CARE, INC.	Senior Total Life Care	www.seniorTLC.org	Senior Total Life Care Medicare (PACE)	08	20		1			H4235	002	0	2015	Gaston, Lincoln and Cleveland Counties in NC		2		2			2								www.seniorTLC.org	www.seniortlc.org									(855)327-7852		(704)874-0600		(855)327-7852		(704)874-0600										(704)874-3307		(704)874-3307		(704)874-3307		(704)874-3307												
H4270	001	0	1	02	01	H4270_001_0	5		1	07/24/2014	2015.01	07/24/2014 01:52:02 PM Central Daylight Time	06/02/2014 09:52:05 PM Central Daylight Time				07/25/2014 04:05:47 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	www.ucare.org	UCare for Seniors Value (HMO-POS)	01	02		1			H4270	001	0	2015	Western Wisconsin - 26 Counties		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500										(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810										2					2					2
H4270	006	0	1	02	01	H4270_006_0	6		1	08/12/2014	2015.01	08/12/2014 01:17:23 PM Central Daylight Time	08/01/2014 10:08:37 AM Central Daylight Time	08/01/2014 10:09:28 AM Central Daylight Time			08/12/2014 01:19:44 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	www.ucare.org	UCare for Seniors Essentials Rx (HMO-POS)	01	02		1			H4270	006	0	2015	Western Wisconsin - 26 Counties		2		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(877)523-1515		(612)676-3600		(877)523-1518		(612)676-3500		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		2					2					2
H4270	801	0	1	02	01	H4270_801_0	2		1	06/02/2014	2015.01	06/02/2014 04:41:11 PM Central Daylight Time	06/02/2014 09:54:41 PM Central Daylight Time				06/02/2014 10:25:53 PM Central Daylight Time	UCARE HEALTH, INC.	UCare	www.ucare.org	Group UCare for Seniors (HMO-POS)	01	02		1			H4270	801	0	2015	Minnesota and 26 Wisconsin counties		1		2			2							www.ucare.org	www.ucare.org	www.ucare.org	(877)523-1515		(612)676-3600		(877)598-6574		(612)676-6900		(877)447-4385		(612)676-6840		(877)598-6574		(612)676-6900		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		(800)688-2534		(612)676-6810		1	2		2		1	2		2		1
H4279	001	0	1	01	01	H4279_001_0	10	2	1	08/06/2014	2015.01	08/06/2014 07:00:13 AM Eastern Daylight Time	08/06/2014 12:57:04 PM Eastern Daylight Time	07/31/2014 04:45:38 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC FOR YOU, INC	UPMC for You	www.upmchealthplan.com/snp	UPMC for You Advantage (HMO SNP)	01	01		1			H4279	001	0	2015	Western PA		2	18500	2			1	3		1	5			http://www.upmchealthplan.com/snp	www.upmchealthplan.com/medicare/partd.html	www.upmchealthplan.com/medicare/partd.html	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		2					2					2
H4279	002	0	1	01	01	H4279_002_0	6		1	08/06/2014	2015.01	08/06/2014 06:59:46 AM Eastern Daylight Time	08/06/2014 12:59:30 PM Eastern Daylight Time	07/31/2014 04:45:49 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC FOR YOU, INC	UPMC for You	www.upmchealthplan.com/snp	UPMC Community Care (HMO SNP)	01	01		1			H4279	002	0	2015	Select PA Counties		2	250	2			1	4		1		00000000000010000000		http://www.upmchealthplan.com/snp	www.upmchealthplan.com/medicare/partd.html	www.upmchealthplan.com/medicare/partd.html	(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(800)606-8648		(800)606-8648		(866)405-8762		(866)405-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		(866)407-8762		2					2					2
H4305	001	0	1	20	08	H4305_001_0	1		1	05/20/2014	2015.01	05/20/2014 02:06:06 PM Central Daylight Time		05/20/2014 04:56:34 PM Central Daylight Time			05/20/2014 04:57:56 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	n/a	Total Life Healthcare Dual (PACE)	08	20		1			H4305	001	0	2015	Counties: Craighead Cross Greene Law MS Poin Rand		2		2			2								n/a	n/a									(855)207-7500		(870)207-7500		(855)207-7500		(870)207-7500										(800)336-0117		(870)336-0117		(800)336-0017		(870)336-0017												
H4305	002	0	1	20	08	H4305_002_0	1		1	05/20/2014	2015.01	05/20/2014 02:06:36 PM Central Daylight Time		05/20/2014 04:56:50 PM Central Daylight Time			05/20/2014 04:57:56 PM Central Daylight Time	TOTAL LIFE HEALTHCARE	Total Life Healthcare	n/a	Total Life Healthcare Medicare only (PACE)	08	20		1			H4305	002	0	2015	Counties:Craighead Cross Greene Law MS Poin Rand		2		2			2								n/a	n/a									(855)207-7500		(870)207-7500		(855)207-7500		(870)207-7500										(800)336-0117		(870)336-0117		(800)336-0017		(870)336-0017												
H4326	001	0	1	20	08	H4326_001_0	1		1	05/30/2014	2015.01	05/30/2014 12:07:40 PM Eastern Daylight Time		05/30/2014 10:11:00 AM Eastern Daylight Time			05/30/2014 03:43:46 PM Eastern Daylight Time	PACE @ HOME, INC.	PACE@Home	www.pace-at-home.org	PACE at Home - dual (PACE)	08	20		1			H4326	001	0	2015	PACE at Home - dual		2		2			2								www.pace-at-home.org	www.seniorscript.com									(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980												
H4326	002	0	1	20	08	H4326_002_0	1		1	05/30/2014	2015.01	05/30/2014 12:08:05 PM Eastern Daylight Time		05/30/2014 10:11:00 AM Eastern Daylight Time			05/30/2014 03:43:46 PM Eastern Daylight Time	PACE @ HOME, INC.	PACE@Home	www.pace-at-home.org	PACE at Home - medicare only (PACE)	08	20		1			H4326	002	0	2015	PACE at Home - medicare only		2		2			2								www.pace-at-home.org	www.seniorscript.com									(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980										(828)468-3980		(828)468-3980		(828)468-3980		(828)468-3980												
H4346	001	0	1	01	01	H4346_001_0	6		1	07/24/2014	2015.01	07/24/2014 11:39:21 AM Pacific Daylight Time	08/04/2014 11:50:11 AM Pacific Daylight Time	08/01/2014 02:45:52 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore Value Plus (HMO)	01	01		1			H4346	001	0	2015	Clark County (partial)		2	2558	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4346	005	0	1	01	01	H4346_005_0	6		1	08/04/2014	2015.01	08/04/2014 01:50:11 PM Pacific Daylight Time	08/04/2014 11:50:58 AM Pacific Daylight Time	08/01/2014 02:46:04 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore Breathe (HMO SNP)	01	01		1			H4346	005	0	2015	Clark County (partial)		2	558	2			1	4		1		00000000000100000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(888)357-4166		(888)357-4166		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4346	006	0	1	01	01	H4346_006_0	6		1	08/04/2014	2015.01	08/04/2014 01:49:44 PM Pacific Daylight Time	08/04/2014 11:50:43 AM Pacific Daylight Time	08/01/2014 02:46:17 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore Diabetes (HMO SNP)	01	01		1			H4346	006	0	2015	Clark County (partial)		2	1390	2			1	4		1		00000010000000000000		www.caremore.com	www.caremore.com	www.caremore.com	(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(888)357-4187		(888)357-4187		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4346	008	0	1	01	01	H4346_008_0	6		1	08/04/2014	2015.01	08/04/2014 01:50:45 PM Pacific Daylight Time	08/04/2014 11:51:13 AM Pacific Daylight Time	08/01/2014 02:46:29 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore Heart (HMO SNP)	01	01		1			H4346	008	0	2015	Clark County (partial)		2	425	2			1	4		1		00000000000000000010		www.caremore.com	www.caremore.com	www.caremore.com	(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(888)494-8280		(888)494-8280		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4346	009	0	1	01	01	H4346_009_0	8		1	07/24/2014	2015.01	07/24/2014 11:43:19 AM Pacific Daylight Time	08/04/2014 11:50:27 AM Pacific Daylight Time	08/01/2014 02:46:42 PM Pacific Daylight Time			08/05/2014 01:42:11 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	www.caremore.com	CareMore StartSmart Plus (HMO)	01	01		1			H4346	009	0	2015	Clark County (partial)		2	652	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(800)822-8720		(800)822-8720		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4346	801	0	1	01	01	H4346_801_0	3		1	05/19/2014	2015.01	05/19/2014 01:56:37 PM Pacific Daylight Time	06/10/2014 11:37:53 AM Pacific Daylight Time				06/10/2014 04:45:52 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore EGWP (HMO)	01	01		1			H4346	801	0	2015	Nevada		1	14	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H4346	802	0	1	01	01	H4346_802_0	3		1	05/19/2014	2015.01	05/19/2014 01:55:29 PM Pacific Daylight Time	06/10/2014 11:37:13 AM Pacific Daylight Time				06/10/2014 04:45:52 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H4346	802	0	2015	Nevada		1	14	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H4346	804	0	1	01	01	H4346_804_0	3		1	05/19/2014	2015.01	05/19/2014 01:56:19 PM Pacific Daylight Time	06/10/2014 11:38:24 AM Pacific Daylight Time				06/10/2014 04:45:52 PM Pacific Daylight Time	CAREMORE HEALTH PLAN OF NEVADA	CareMore Health Plan of Nevada	caremore.com	CareMore EGWP MAPD (HMO)	01	01		1			H4346	804	0	2015	Nevada		1	5	2			2							www.caremore.com	www.caremore.com	www.caremore.com	(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(800)822-6991		(800)822-6991		(866)622-2820		(866)622-2820		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111011111	1	111111111111111111111110111	1					1
H4393	001	0	1	20	08	H4393_001_0	2		1	05/30/2014	2015.01	05/30/2014 06:07:30 PM Eastern Daylight Time		05/30/2014 06:02:39 PM Eastern Daylight Time			06/02/2014 10:49:01 AM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Senior Life	http://www.archcare.org/	ArchCare Senior Life - Dual (PACE)	08	20		1			H4393	001	0	2015	New York, Bronx, and Richmond counties		2		2			2								www.archcare.org	www.archcare.org									(212)752-2404		(212)752-2404		(212)752-2404		(212)752-2404										(800)662-1200		(800)662-1200		(800)662-1200		(800)662-1200												
H4393	002	0	1	20	08	H4393_002_0	2		1	05/30/2014	2015.01	05/30/2014 06:08:03 PM Eastern Daylight Time		05/30/2014 06:02:39 PM Eastern Daylight Time			06/02/2014 10:49:01 AM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Senior Life	http://www.archcare.org/	ArchCare Senior Life - Medicare only (PACE)	08	20		1			H4393	002	0	2015	New York, Bronx, and Richmond counties		2		2			2								www.archcare.org	www.archcare.org									(212)752-2404		(212)752-2404		(212)752-2404		(212)752-2404										(800)662-1200		(800)662-1200		(800)662-1200		(800)662-1200												
H4402	001	0	1	20	08	H4402_001_0	1		1	05/20/2014	2015.01	05/20/2014 11:43:27 AM Eastern Daylight Time		05/16/2014 03:12:07 PM Eastern Daylight Time			05/20/2014 12:01:16 PM Eastern Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	WWW.alexianbrotherssoutheast.com	Alexian Brothers Community Services (PACE)	08	20		1			H4402	001	0	2015	Hamilton County Area		2		2			2								None	None									(800)443-8883		(423)698-0802		(800)443-8883		(423)698-0802										(800)443-8883		(423)698-0802		(800)443-8883		(423)698-0802												
H4402	002	0	1	20	08	H4402_002_0	2		1	05/20/2014	2015.01	05/20/2014 11:44:08 AM Eastern Daylight Time		05/16/2014 03:25:37 PM Eastern Daylight Time			05/20/2014 01:10:04 PM Eastern Daylight Time	ALEXIAN BROTHERS COMMUNITY SERVICES	Alexian Brothers Community Services	WWW.alexianbrotherssoutheast.com	Alexian Brothers Community Services (PACE)	08	20		1			H4402	002	0	2015	Hamilton County Area		2		2			2								None	None									(800)441-8883		(423)698-0802		(800)443-8883		(423)698-0802										(800)441-8883		(423)698-0802		(800)443-8883		(423)698-0802												
H4407	002	0	1	01	01	H4407_002_0	4		1	07/16/2014	2015.02	07/16/2014 02:34:33 PM Central Daylight Time	08/04/2014 01:25:42 PM Central Daylight Time	07/31/2014 03:46:09 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred SMS (HMO)	01	01		1			H4407	002	0	2015	Southern Mississippi		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4407	004	0	1	01	01	H4407_004_0	4	2	1	07/16/2014	2015.02	07/16/2014 02:34:46 PM Central Daylight Time	08/04/2014 01:26:13 PM Central Daylight Time	07/31/2014 03:46:20 PM Central Daylight Time			08/05/2014 09:20:46 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare SMS (HMO SNP)	01	01		1			H4407	004	0	2015	Southern Mississippi		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4407	011	0	1	01	01	H4407_011_0	2		1	07/16/2014	2015.02	07/16/2014 02:35:01 PM Central Daylight Time	05/27/2014 09:39:07 AM Central Daylight Time				07/17/2014 09:49:34 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage SMS (HMO)	01	01		1			H4407	011	0	2015	Southern Mississippi		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2
H4454	002	0	1	01	01	H4454_002_0	5		1	07/17/2014	2015.02	07/17/2014 09:26:13 AM Central Daylight Time	08/04/2014 07:20:07 PM Central Daylight Time	07/31/2014 03:55:36 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4454	002	0	2015	Tennessee		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	012	0	1	01	01	H4454_012_0	2		1	07/17/2014	2015.02	07/17/2014 09:26:35 AM Central Daylight Time	05/28/2014 05:08:02 PM Central Daylight Time				07/18/2014 12:38:09 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4454	012	0	2015	Tennessee		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										2					2					2
H4454	020	0	1	01	01	H4454_020_0	4	2	1	07/17/2014	2015.02	07/17/2014 09:27:33 AM Central Daylight Time	05/28/2014 05:08:22 PM Central Daylight Time	07/31/2014 03:55:46 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4454	020	0	2015	Middle and West Tennessee		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	028	0	1	01	01	H4454_028_0	5		1	07/17/2014	2015.02	07/17/2014 09:28:24 AM Central Daylight Time	06/04/2014 03:41:29 PM Central Daylight Time	07/31/2014 03:55:56 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Primary (HMO)	01	01		1			H4454	028	0	2015	East Tennessee		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	030	0	1	02	01	H4454_030_0	4		1	07/17/2014	2015.02	07/17/2014 09:35:18 AM Central Daylight Time	08/04/2014 07:24:56 PM Central Daylight Time	07/31/2014 03:56:07 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H4454	030	0	2015	Tennessee		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	031	0	1	01	01	H4454_031_0	4		1	07/17/2014	2015.02	07/17/2014 09:35:38 AM Central Daylight Time	08/04/2014 07:25:33 PM Central Daylight Time	07/31/2014 03:56:17 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred KNX (HMO)	01	01		1			H4454	031	0	2015	Knoxville		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	032	0	1	02	01	H4454_032_0	4		1	07/17/2014	2015.02	07/17/2014 09:36:22 AM Central Daylight Time	05/28/2014 05:09:41 PM Central Daylight Time	07/31/2014 03:56:27 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier KNX (HMO-POS)	01	02		1			H4454	032	0	2015	Knoxville		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	033	0	1	01	01	H4454_033_0	4		1	07/17/2014	2015.02	07/17/2014 09:36:39 AM Central Daylight Time	08/04/2014 07:26:09 PM Central Daylight Time	07/31/2014 03:56:37 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred AR (HMO)	01	01		1			H4454	033	0	2015	Arkansas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	034	0	1	01	01	H4454_034_0	4	2	1	07/17/2014	2015.02	07/17/2014 09:37:16 AM Central Daylight Time	05/28/2014 05:10:22 PM Central Daylight Time	07/31/2014 03:56:48 PM Central Daylight Time			08/05/2014 10:27:54 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare AR (HMO SNP)	01	01		1			H4454	034	0	2015	Arkansas		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4454	805	0	1	01	01	H4454_805_0	1		1	04/29/2014	2015.02	04/29/2014 10:01:14 PM Central Daylight Time	05/28/2014 05:10:41 PM Central Daylight Time				05/29/2014 09:21:37 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4454	805	0	2015	Tennessee, Mississippi, Illinois		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101110111111011111000110	1	110000111011011111110010110	1					1
H4454	809	0	1	02	01	H4454_809_0	2		1	04/29/2014	2015.02	04/29/2014 10:01:41 PM Central Daylight Time	06/04/2014 03:41:49 PM Central Daylight Time				06/09/2014 10:33:51 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4454	809	0	2015	Tennessee, Mississippi, Illinois		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000101011011111110010110	1	2		2		1
H4454	810	0	1	01	01	H4454_810_0	2		1	04/29/2014	2015.02	04/29/2014 10:02:02 PM Central Daylight Time	06/04/2014 03:42:10 PM Central Daylight Time				06/09/2014 10:33:51 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H4454	810	0	2015	Tennessee, Mississippi, Illinois		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H4454	811	0	1	01	01	H4454_811_0	2		1	05/09/2014	2015.02	05/09/2014 02:26:49 PM Central Daylight Time	06/04/2014 03:42:30 PM Central Daylight Time				06/09/2014 10:33:51 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H4454	811	0	2015	Tennessee, Mississippi, Illinois		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1					1
H4454	812	0	1	02	01	H4454_812_0	2		1	05/05/2014	2015.02	05/05/2014 05:56:52 PM Central Daylight Time	06/04/2014 03:42:50 PM Central Daylight Time				06/09/2014 10:33:51 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H4454	812	0	2015	Tennessee, Mississippi, Illinois		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	2		2		2
H4454	813	0	1	02	01	H4454_813_0	2		1	04/29/2014	2015.02	04/29/2014 10:49:13 PM Central Daylight Time	06/04/2014 03:43:10 PM Central Daylight Time				06/09/2014 10:33:51 AM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H4454	813	0	2015	Tennessee, Mississippi, Illinois		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010101111111111011111000110	1	110000111011011111110010110	1	2		2		1
H4456	010	0	1	01	01	H4456_010_0	2		1	05/19/2014	2015.02	05/19/2014 05:32:53 PM Central Daylight Time	08/04/2014 03:34:40 PM Central Daylight Time	07/31/2014 03:18:28 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4456	010	0	2015	Select counties in Illinois		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4456	013	0	1	01	01	H4456_013_0	2		1	05/30/2014	2015.02	05/30/2014 04:26:32 PM Central Daylight Time	08/04/2014 03:34:53 PM Central Daylight Time	07/31/2014 03:18:31 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4456	013	0	2015	Eastern Tennessee and Southwestern Virginia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4456	021	0	1	01	01	H4456_021_0	2		1	05/30/2014	2015.02	05/30/2014 04:27:13 PM Central Daylight Time	08/04/2014 03:35:07 PM Central Daylight Time	07/31/2014 03:18:34 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4456	021	0	2015	Eastern Tennessee and Southwestern Virginia		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4456	025	0	1	01	01	H4456_025_0	2		1	05/19/2014	2015.02	05/19/2014 05:33:12 PM Central Daylight Time	08/04/2014 03:35:21 PM Central Daylight Time	07/31/2014 03:18:37 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4456	025	0	2015	Select counties in Iowa		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4456	801	0	1	01	01	H4456_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:14:36 AM Central Daylight Time	05/30/2014 05:53:01 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4456	801	0	2015	Eastern Tennessee and Southwestern Virginia		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4456	805	0	1	01	01	H4456_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:14:47 AM Central Daylight Time	05/30/2014 05:53:18 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4456	805	0	2015	Eastern Tennessee and Southwestern Virginia		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H4456	810	0	1	01	01	H4456_810_0	1		1	05/22/2014	2015.01	05/22/2014 09:14:57 AM Central Daylight Time	05/30/2014 05:53:36 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4456	810	0	2015	Select counties in IL		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4461	004	0	1	01	01	H4461_004_0	2		1	07/10/2014	2015.02	07/10/2014 03:45:25 PM Eastern Daylight Time	07/09/2014 03:57:38 PM Eastern Daylight Time				07/14/2014 12:58:28 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-004 (HMO)	01	01		1			H4461	004	0	2015	East Tennessee		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H4461	018	0	1	01	01	H4461_018_0	3		1	07/10/2014	2015.02	07/10/2014 03:47:57 PM Eastern Daylight Time	08/02/2014 01:20:45 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-018 (HMO)	01	01		1			H4461	018	0	2015	Nashville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	022	0	1	01	01	H4461_022_0	5	2	1	08/11/2014	2015.02	08/11/2014 02:53:42 PM Eastern Daylight Time	08/07/2014 03:02:23 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/11/2014 04:02:27 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4461-022 (HMO SNP)	01	01		1			H4461	022	0	2015	Greater Tennessee		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	025	0	1	01	01	H4461_025_0	3		1	08/02/2014	2015.02	08/02/2014 04:43:20 PM Eastern Daylight Time	08/02/2014 01:15:34 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-025 (HMO)	01	01		1			H4461	025	0	2015	Memphis Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	029	0	1	01	01	H4461_029_0	5		1	08/11/2014	2015.02	08/11/2014 02:54:02 PM Eastern Daylight Time	08/07/2014 03:11:24 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/11/2014 04:02:27 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-029 (HMO)	01	01		1			H4461	029	0	2015	Nashville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	030	1	1	01	01	H4461_030_1	3		1	07/11/2014	2015.02	07/11/2014 09:37:02 AM Eastern Daylight Time	08/02/2014 01:17:36 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	1	2015	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	030	2	1	01	01	H4461_030_2	3		1	07/11/2014	2015.02	07/11/2014 09:39:20 AM Eastern Daylight Time	08/02/2014 01:17:57 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	2	2015	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	030	3	1	01	01	H4461_030_3	3		1	07/11/2014	2015.02	07/11/2014 09:41:42 AM Eastern Daylight Time	08/02/2014 01:18:18 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-030 (HMO)	01	01		1			H4461	030	3	2015	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	031	1	1	01	01	H4461_031_1	3		1	07/10/2014	2015.02	07/10/2014 04:06:55 PM Eastern Daylight Time	08/02/2014 01:18:39 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	1	2015	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	031	2	1	01	01	H4461_031_2	3		1	07/10/2014	2015.02	07/10/2014 04:09:10 PM Eastern Daylight Time	08/02/2014 01:19:01 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	2	2015	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	031	3	1	01	01	H4461_031_3	3		1	07/10/2014	2015.02	07/10/2014 04:13:18 PM Eastern Daylight Time	08/02/2014 01:19:21 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Gold Plus H4461-031 (HMO)	01	01		1			H4461	031	3	2015	East Tennessee	East Tennessee	2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4461	806	0	1	01	01	H4461_806_0	2		1	05/23/2014	2015.02	05/23/2014 02:51:20 PM Eastern Daylight Time	07/14/2014 10:57:07 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4461	806	0	2015	Select counties in East Tennessee area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4461	807	0	1	01	01	H4461_807_0	2		1	05/23/2014	2015.02	05/23/2014 02:51:59 PM Eastern Daylight Time	07/14/2014 10:57:53 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	CARITEN HEALTH PLAN INC.	Cariten Health Plan Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4461	807	0	2015	Select counties in East Tennessee area		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4465	001	0	1	48	05	H4465_001_0	4		1	08/29/2014	2015.01	08/29/2014 12:02:21 PM Eastern Daylight Time					08/29/2014 12:03:32 PM Eastern Daylight Time	INDEPENDENCE CARE SYSTEM, INC.	ICS Community Care Plus FIDA MMP	www.icsny.org	ICS Community Care Plus FIDA MMP (Medicare-Medicaid Plan)	05	48		1			H4465	001	0	2015	Manhattan, Kings, Bronx, Queens Counties		2	5000	2			2								www.icsny.org	www.icsny.org	(877)427-2525		(212)584-2500		(877)427-8787		(212)584-2500		(877)427-8787		(212)584-2500		(877)427-8787		(212)584-2500		(877)427-2525		(646)653-6000		(877)427-8787		(646)653-6000		(877)427-8787		(646)653-6000		(877)427-8787		(646)653-6000		2					2					2
H4506	003	0	1	01	01	H4506_003_0	7		1	08/05/2014	2015.01	08/05/2014 05:17:47 PM Central Daylight Time	08/04/2014 03:36:58 PM Central Daylight Time	07/31/2014 04:27:29 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	TexanPlus Classic (HMO)	01	01		1			H4506	003	0	2015	Houston/Beaumont Area		2		2			2							www.TexanPlus.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4506	010	0	1	01	01	H4506_010_0	4		1	07/21/2014	2015.01	07/21/2014 05:08:24 PM Central Daylight Time	07/18/2014 03:24:41 PM Central Daylight Time				07/21/2014 05:27:52 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	TexanPlus Value (HMO)	01	01		1			H4506	010	0	2015	Houston/Beaumont Area		2		2			2							www.TexanPlus.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										2					2					2
H4506	029	0	1	02	01	H4506_029_0	8		1	08/05/2014	2015.01	08/05/2014 05:17:56 PM Central Daylight Time	08/04/2014 03:37:30 PM Central Daylight Time	07/31/2014 04:27:35 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlusPOS.com	TexanPlus Choice (HMO-POS)	01	02		1			H4506	029	0	2015	Houston/Beaumont Area		2		2			2							www.TexanPlusPOS.com	www.TexanPlusPOS.com	www.TexanPlusPOS.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4506	801	0	1	01	01	H4506_801_0	2		1	05/29/2014	2015.01	05/29/2014 11:58:50 AM Central Daylight Time	05/31/2014 07:33:22 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	H4506 - Retiree - MA-PD non-CY (HMO)	01	01		1			H4506	801	0	2015	TexanPlus-Employer Group (MAPD nonCY)		1		2			2							www.Universal-American-Medicare.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4506	806	0	1	01	01	H4506_806_0	2		1	05/29/2014	2015.01	05/29/2014 11:59:11 AM Central Daylight Time	05/31/2014 07:33:49 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	H4506 - Retiree - MA-PD CY (HMO)	01	01		1			H4506	806	0	2015	TexanPlus-Employer Group (MAPD CY)		1		2			2							www.Universal-American-Medicare.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4506	808	0	1	01	01	H4506_808_0	2		1	05/29/2014	2015.01	05/29/2014 11:59:33 AM Central Daylight Time	05/31/2014 07:34:30 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	SELECTCARE OF TEXAS, INC.	Universal American Corp.	www.TexanPlus.com	H4506 - Retiree MA (HMO)	01	01		1			H4506	808	0	2015	TexanValue-Employer Group (MA Only)		1		2			2							www.Universal-American-Medicare.com	www.TexanPlus.com	www.TexanPlus.com	(866)230-2513		(866)230-2513		(866)556-4607		(866)556-4607										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4510	012	0	1	01	01	H4510_012_0	4		1	08/02/2014	2015.02	08/02/2014 02:33:03 PM Eastern Daylight Time	08/05/2014 02:05:56 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-012 (HMO)	01	01		1			H4510	012	0	2015	Corpus Christi Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	015	0	1	01	01	H4510_015_0	3		1	08/02/2014	2015.02	08/02/2014 02:37:25 PM Eastern Daylight Time	08/05/2014 02:04:25 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-015 (HMO)	01	01		1			H4510	015	0	2015	San Antonio Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	018	0	1	01	01	H4510_018_0	3		1	08/04/2014	2015.02	08/04/2014 03:37:28 PM Eastern Daylight Time	08/05/2014 02:17:35 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-018 (HMO)	01	01		1			H4510	018	0	2015	Dallas Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	021	0	1	01	01	H4510_021_0	4	2	1	07/10/2014	2015.02	07/10/2014 05:15:19 PM Eastern Daylight Time	08/05/2014 02:16:03 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4510-021 (HMO SNP)	01	01		1			H4510	021	0	2015	Select Counties in Texas		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	022	0	1	01	01	H4510_022_0	3		1	08/02/2014	2015.02	08/02/2014 02:38:50 PM Eastern Daylight Time	08/05/2014 02:15:13 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-022 (HMO)	01	01		1			H4510	022	0	2015	El Paso County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	024	0	1	01	01	H4510_024_0	4	2	1	07/10/2014	2015.02	07/10/2014 05:16:05 PM Eastern Daylight Time	08/05/2014 02:06:54 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus SNP-DE H4510-024 (HMO SNP)	01	01		1			H4510	024	0	2015	Corpus Christi/San Antonio area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	027	0	1	01	01	H4510_027_0	3		1	08/02/2014	2015.02	08/02/2014 02:41:44 PM Eastern Daylight Time	08/05/2014 02:09:55 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-027 (HMO)	01	01		1			H4510	027	0	2015	Hays, Travis and Williamson		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	028	0	1	01	01	H4510_028_0	3		1	08/04/2014	2015.02	08/04/2014 03:38:11 PM Eastern Daylight Time	08/05/2014 02:10:36 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-028 (HMO)	01	01		1			H4510	028	0	2015	Houston Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	029	0	1	01	01	H4510_029_0	3		1	08/04/2014	2015.02	08/04/2014 10:33:55 AM Eastern Daylight Time	08/05/2014 02:11:19 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus SNP-CHF/DM H4510-029 (HMO SNP)	01	01		1			H4510	029	0	2015	Corpus Christi Metro Area		2		2			1	4		1		00000000000000000100		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	030	0	1	01	01	H4510_030_0	4		1	08/04/2014	2015.02	08/04/2014 10:34:09 AM Eastern Daylight Time	08/05/2014 02:12:18 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus SNP-CHF/DM H4510-030 (HMO SNP)	01	01		1			H4510	030	0	2015	San Antonio Metro Area		2		2			1	4		1		00000000000000000100		www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	032	0	1	01	01	H4510_032_0	3		1	08/02/2014	2015.02	08/02/2014 02:46:05 PM Eastern Daylight Time	08/05/2014 02:16:44 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Gold Plus H4510-032 (HMO)	01	01		1			H4510	032	0	2015	Select Counties in Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4510	801	0	1	01	01	H4510_801_0	2		1	05/23/2014	2015.02	05/23/2014 02:52:39 PM Eastern Daylight Time	07/14/2014 10:44:52 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4510	801	0	2015	Select counties in Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4510	802	0	1	01	01	H4510_802_0	2		1	05/23/2014	2015.02	05/23/2014 02:53:19 PM Eastern Daylight Time	07/14/2014 10:56:21 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4510	802	0	2015	Select counties in Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4510	805	0	1	01	01	H4510_805_0	2		1	05/23/2014	2015.02	05/23/2014 02:53:58 PM Eastern Daylight Time	07/14/2014 11:13:55 AM Eastern Daylight Time				07/14/2014 02:03:46 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF TEXAS, INC.	HUMANA HEALTH PLAN OF TEXAS, INC.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H4510	805	0	2015	Bexar County		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H4513	009	0	1	01	01	H4513_009_0	2		1	07/16/2014	2015.02	07/16/2014 03:08:54 PM Central Daylight Time	05/25/2014 03:05:24 PM Central Daylight Time				07/18/2014 12:54:51 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H4513	009	0	2015	Texas HealthSpring Counties		2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2					2
H4513	010	0	1	01	01	H4513_010_0	4	2	1	07/16/2014	2015.02	07/16/2014 03:09:03 PM Central Daylight Time	08/04/2014 08:16:06 AM Central Daylight Time	07/31/2014 03:59:06 PM Central Daylight Time			08/05/2014 10:38:40 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4513	010	0	2015	Texas HealthSpring Counties		2		2			1	3		1	2				www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4513	024	1	1	01	01	H4513_024_1	4		1	07/16/2014	2015.02	07/16/2014 03:09:16 PM Central Daylight Time	08/04/2014 08:16:36 AM Central Daylight Time	07/31/2014 03:59:16 PM Central Daylight Time			08/05/2014 10:38:40 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	024	1	2015	Texas	Texas Preferred	2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4513	024	2	1	01	01	H4513_024_2	4		1	07/16/2014	2015.02	07/16/2014 03:09:26 PM Central Daylight Time	08/04/2014 08:17:06 AM Central Daylight Time	07/31/2014 03:59:26 PM Central Daylight Time			08/05/2014 10:38:40 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4513	024	2	2015	Texas	Texas Preferred Select Counties	2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4513	804	0	1	01	01	H4513_804_0	1		1	05/15/2014	2015.02	05/15/2014 10:33:08 AM Central Daylight Time	05/25/2014 03:09:58 PM Central Daylight Time				05/29/2014 10:04:10 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H4513	804	0	2015	Texas		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011111111111111111101111110	1	110000111011011111110111111	1					1
H4513	808	0	1	02	01	H4513_808_0	1		1	05/15/2014	2015.02	05/15/2014 10:43:20 AM Central Daylight Time	05/25/2014 03:13:35 PM Central Daylight Time				05/29/2014 10:04:10 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H4513	808	0	2015	Texas		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011111111111111111101111110	1	110000111011011111110111111	1	1	011111111011111111111111111101111100	1	110000111011011111110111110	1
H4513	809	0	1	01	01	H4513_809_0	2		1	05/15/2014	2015.02	05/15/2014 10:34:03 AM Central Daylight Time	07/08/2014 08:25:36 AM Central Daylight Time				07/11/2014 02:07:59 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H4513	809	0	2015	Texas		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										1	1	011111111011111111111111111101111110	1	110000111011011111110111111	1					1
H4513	810	0	1	01	01	H4513_810_0	2		1	05/15/2014	2015.02	05/15/2014 10:34:34 AM Central Daylight Time	07/08/2014 08:26:14 AM Central Daylight Time				07/11/2014 02:07:59 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H4513	810	0	2015	Texas		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011111111111111111101111110	1	110000111011011111110111111	1					1
H4513	811	0	1	02	01	H4513_811_0	2		1	05/15/2014	2015.02	05/15/2014 10:44:00 AM Central Daylight Time	07/08/2014 08:26:45 AM Central Daylight Time				07/11/2014 02:07:59 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H4513	811	0	2015	Texas		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										1	1	011111111011111111111111111101111110	1	110000111011011111110111111	1	1	011111111011111111111111111101111100	1	110000111011011111110111110	1
H4513	812	0	1	02	01	H4513_812_0	2		1	05/15/2014	2015.02	05/15/2014 10:44:36 AM Central Daylight Time	07/08/2014 08:27:15 AM Central Daylight Time				07/11/2014 02:07:59 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H4513	812	0	2015	Texas		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(888)281-7867		(888)281-7867		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011111111111111111101111110	1	110000111011011111110111111	1	1	011111111011111111111111111101111100	1	110000111011011111110111110	1
H4514	001	0	1	01	01	H4514_001_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:51:55 AM Central Daylight Time	08/12/2014 09:37:52 AM Central Daylight Time	07/31/2014 03:18:41 PM Central Daylight Time			08/12/2014 02:49:26 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4514	001	0	2015	Houston and Austin metro areas		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4514	007	0	1	01	01	H4514_007_0	2		1	05/23/2014	2015.02	05/23/2014 01:38:59 PM Central Daylight Time	08/04/2014 02:58:33 PM Central Daylight Time	07/31/2014 03:18:44 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H4514	007	0	2015	Houston area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4514	012	0	1	01	01	H4514_012_0	5		1	07/18/2014	2015.02	07/18/2014 09:35:28 AM Central Daylight Time	08/12/2014 09:48:45 AM Central Daylight Time	07/31/2014 03:18:48 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H4514	012	0	2015	Harris County		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4514	801	0	1	01	01	H4514_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:15:08 AM Central Daylight Time	05/30/2014 05:55:58 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	801	0	2015	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4514	803	0	1	01	01	H4514_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:15:16 AM Central Daylight Time	05/30/2014 05:56:15 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	803	0	2015	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H4514	806	0	1	01	01	H4514_806_0	1		1	05/22/2014	2015.01	05/22/2014 09:15:24 AM Central Daylight Time	05/30/2014 05:56:32 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, LLC	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4514	806	0	2015	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4517	001	0	1	20	08	H4517_001_0	1		1	05/21/2014	2015.01	05/21/2014 07:28:49 AM Central Daylight Time		05/20/2014 02:31:30 PM Central Daylight Time			05/21/2014 07:33:55 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The basics at Jan Werner	alana@janwerneradultdaycare.org	DUAL ELIGIBLE (PACE)	08	20		1			H4517	001	0	2015	Potter, TX and Randall, TX Counties		2	150	2			2								N/A	N/A									(888)299-6401		(806)374-5516		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-5516		(800)735-2989		(806)374-5516												
H4517	002	0	1	20	08	H4517_002_0	1		1	05/21/2014	2015.01	05/21/2014 07:30:48 AM Central Daylight Time		05/20/2014 02:39:57 PM Central Daylight Time			05/21/2014 07:33:55 AM Central Daylight Time	AMARILLO MULTISVC CTR FR THE AGING INC	The basics at Jan Werner	alana@janwerneradultdaycare.org	MEDICARE ONLY (PACE)	08	20		1			H4517	002	0	2015	Potter, TX and Randall, TX Counties		2	150	2			2								N/A	N/A									(888)299-6401		(806)374-5516		(888)299-6401		(806)374-5516										(800)735-2989		(806)374-5516		(800)735-2989		(806)374-5516												
H4518	001	0	1	20	08	H4518_001_0	1		1	05/20/2014	2015.01	05/20/2014 08:03:25 AM Mountain Daylight Time		05/19/2014 02:05:09 PM Mountain Daylight Time			05/20/2014 08:08:14 AM Mountain Daylight Time	BIENVIVIR SENIOR HEALTH SERVICES	Bienvivir Senior Health Services	www.Bienvivir.org	BSHS Part D, Dual Eligibles (PACE)	08	20		1			H4518	001	0	2015	El Paso, Texas and El Paso County		2		2			2								www.bienvivir.org	www.bienvivir.org									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801											
H4518	002	0	1	20	08	H4518_002_0	1		1	05/20/2014	2015.01	05/20/2014 07:58:55 AM Mountain Daylight Time		05/19/2014 02:01:54 PM Mountain Daylight Time			05/20/2014 08:08:14 AM Mountain Daylight Time	BIENVIVIR SENIOR HEALTH SERVICES	Bienvivir Senior Health Services	www.Bienvivir.org	BSHS Part D, Medicare Only (PACE)	08	20		1			H4518	002	0	2015	El Paso, Texas and El Paso County		2		2			2								www.bienvivir.org	www.bienvivir.org									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801									(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801	(915)562-3444	1801											
H4522	001	0	1	04	01	H4522_001_0	2		1	05/21/2014	2015.02	05/21/2014 05:20:12 PM Central Daylight Time	08/04/2014 04:59:07 PM Central Daylight Time	07/31/2014 03:18:52 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H4522	001	0	2015	El Paso area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4522	007	0	1	04	01	H4522_007_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:03:05 AM Central Daylight Time	08/04/2014 04:59:46 PM Central Daylight Time	07/31/2014 03:18:55 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H4522	007	0	2015	El Paso County		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4522	010	0	1	04	01	H4522_010_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:03:11 AM Central Daylight Time	08/04/2014 05:00:24 PM Central Daylight Time	07/31/2014 03:18:59 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H4522	010	0	2015	Dona Ana, Grant, Hidalgo, Luna and Sierra counties		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4523	001	0	1	01	01	H4523_001_0	5		1	08/02/2014	2015.01	08/02/2014 09:31:41 PM Eastern Daylight Time	08/02/2014 01:37:48 PM Eastern Daylight Time	08/01/2014 09:54:27 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	001	0	2015	Bexar and Comal Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	005	0	1	01	01	H4523_005_0	7		1	08/05/2014	2015.01	08/05/2014 04:41:24 PM Eastern Daylight Time	08/02/2014 11:16:24 AM Eastern Daylight Time	08/01/2014 09:54:37 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	005	0	2015	Collin, Dallas and Denton Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	015	0	1	01	01	H4523_015_0	5		1	08/02/2014	2015.01	08/02/2014 09:33:48 PM Eastern Daylight Time	08/02/2014 01:39:24 PM Eastern Daylight Time	08/01/2014 09:59:18 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H4523	015	0	2015	Harris and Montgomery Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	016	0	1	01	01	H4523_016_0	3		1	08/02/2014	2015.01	08/02/2014 09:34:19 PM Eastern Daylight Time	08/02/2014 12:00:36 PM Eastern Daylight Time	08/01/2014 09:59:28 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H4523	016	0	2015	Surrounding Counties of San Antonio Metro		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	017	0	1	01	01	H4523_017_0	3		1	08/02/2014	2015.01	08/02/2014 09:34:40 PM Eastern Daylight Time	08/02/2014 12:08:12 PM Eastern Daylight Time	08/01/2014 09:59:38 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H4523	017	0	2015	Surrounding Counties of Dallas Metro		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	018	0	1	01	01	H4523_018_0	3		1	08/02/2014	2015.01	08/02/2014 09:35:07 PM Eastern Daylight Time	08/02/2014 01:40:48 PM Eastern Daylight Time	08/01/2014 09:59:47 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H4523	018	0	2015	Surrounding Counties of Houston Metro		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	019	0	1	01	01	H4523_019_0	4		1	08/02/2014	2015.01	08/02/2014 09:35:35 PM Eastern Daylight Time	08/02/2014 11:18:50 AM Eastern Daylight Time	08/01/2014 09:59:57 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H4523	019	0	2015	Tarrant County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	020	0	1	01	01	H4523_020_0	6		1	08/02/2014	2015.01	08/02/2014 09:32:16 PM Eastern Daylight Time	08/06/2014 02:51:26 PM Eastern Daylight Time	08/01/2014 10:00:07 AM Eastern Daylight Time			08/06/2014 10:12:36 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	020	0	2015	Bexar and Comal counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	021	0	1	01	01	H4523_021_0	5		1	08/02/2014	2015.01	08/02/2014 09:33:05 PM Eastern Daylight Time	08/02/2014 01:41:40 PM Eastern Daylight Time	08/01/2014 10:00:17 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H4523	021	0	2015	Collin, Dallas and Denton counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4523	801	0	1	01	01	H4523_801_0	3		1	05/23/2014	2015.01	05/23/2014 01:25:35 PM Eastern Daylight Time	07/24/2014 03:32:16 PM Eastern Daylight Time				07/24/2014 03:45:20 PM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4523	801	0	2015	Texas		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H4523	802	0	1	01	01	H4523_802_0	2		1	05/23/2014	2015.01	05/23/2014 01:38:53 PM Eastern Daylight Time	06/01/2014 01:45:36 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (TX)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H4523	802	0	2015	Texas		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H4525	001	0	1	01	01	H4525_001_0	6		1	07/11/2014	2015.01	07/11/2014 10:17:36 AM Central Daylight Time	08/05/2014 12:25:48 PM Central Daylight Time	08/05/2014 12:24:48 PM Central Daylight Time			08/06/2014 09:07:31 AM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	001	0	2015	FirstCare Advantage Gold (Abilene Region)		2	225	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2
H4525	002	0	1	01	01	H4525_002_0	5		1	07/11/2014	2015.01	07/11/2014 10:35:26 AM Central Daylight Time	08/05/2014 12:25:55 PM Central Daylight Time	08/05/2014 12:24:53 PM Central Daylight Time			08/06/2014 09:09:01 AM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	002	0	2015	FirstCare Advantage Gold (Lubbock Region)		2	2011	2			2							www.firstcare.com	www.firstcare.com/advantage	www,firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2
H4525	003	0	1	01	01	H4525_003_0	7	2	1	08/05/2014	2015.01	08/05/2014 12:48:47 PM Central Daylight Time	08/05/2014 12:26:02 PM Central Daylight Time	08/05/2014 12:24:57 PM Central Daylight Time			08/06/2014 09:11:31 AM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Select (HMO SNP)	01	01		1			H4525	003	0	2015	FirstCare Advantage Select		2	1525	2			1	3		1	2			www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2
H4525	004	0	1	01	01	H4525_004_0	4		1	07/11/2014	2015.01	07/11/2014 10:40:16 AM Central Daylight Time	07/24/2014 03:13:18 PM Central Daylight Time				07/24/2014 05:25:52 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	004	0	2015	FirstCare Advantage Silver (Abilene Region)		2	21	2			2							www.firstcare.com	www,firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2
H4525	005	0	1	01	01	H4525_005_0	3		1	07/11/2014	2015.01	07/11/2014 10:44:07 AM Central Daylight Time	07/24/2014 03:14:15 PM Central Daylight Time				07/24/2014 05:27:04 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	005	0	2015	FirstCare Advantage Silver (Lubbock Region)		2	59	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2
H4525	010	0	1	01	01	H4525_010_0	5		1	07/11/2014	2015.01	07/11/2014 10:48:53 AM Central Daylight Time	08/05/2014 12:26:10 PM Central Daylight Time	08/05/2014 12:25:00 PM Central Daylight Time			08/06/2014 09:12:43 AM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	010	0	2015	FirstCare Advantage Gold (Midland/Odessa Region)		2	240	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2
H4525	011	0	1	01	01	H4525_011_0	3		1	07/11/2014	2015.01	07/11/2014 10:51:00 AM Central Daylight Time	07/24/2014 03:14:11 PM Central Daylight Time				07/24/2014 05:29:13 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	011	0	2015	FirstCare Advantage Silver (Midland/Odessa Region)		2	5	2			2							www,firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2
H4525	012	0	1	01	01	H4525_012_0	5		1	07/11/2014	2015.01	07/11/2014 10:53:46 AM Central Daylight Time	08/05/2014 12:25:32 PM Central Daylight Time	08/05/2014 12:25:03 PM Central Daylight Time			08/06/2014 09:14:08 AM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	012	0	2015	FirstCare Advantage Gold (Amarillo Region)		2	236	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2
H4525	013	0	1	01	01	H4525_013_0	3		1	07/11/2014	2015.01	07/11/2014 10:56:33 AM Central Daylight Time	07/24/2014 03:13:48 PM Central Daylight Time				07/24/2014 05:31:43 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	013	0	2015	FirstCare Advantage Silver (Amarillo Region)		2	5	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2
H4525	014	0	1	01	01	H4525_014_0	6		1	07/11/2014	2015.01	07/11/2014 10:59:06 AM Central Daylight Time	08/05/2014 12:25:38 PM Central Daylight Time	08/05/2014 12:24:44 PM Central Daylight Time			08/06/2014 09:15:28 AM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Gold (HMO)	01	01		1			H4525	014	0	2015	FirstCare Advantage Gold (San Angelo Region)		2	236	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		2					2					2
H4525	015	0	1	01	01	H4525_015_0	4		1	07/11/2014	2015.01	07/11/2014 11:01:23 AM Central Daylight Time	07/24/2014 03:13:46 PM Central Daylight Time				07/24/2014 05:33:54 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Silver (HMO)	01	01		1			H4525	015	0	2015	FirstCare Advantage Silver (San Angelo Region)		2	5	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										2					2					2
H4525	802	0	1	01	01	H4525_802_0	2		1	05/27/2014	2015.01	05/27/2014 05:27:56 PM Central Daylight Time	07/24/2014 03:15:03 PM Central Daylight Time				07/24/2014 05:35:04 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (D) (HMO)	01	01		1			H4525	802	0	2015	FirstCare Advantage Employer (D)		1	100	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		1	1	011000011000000001010100001100000100	2		1					1
H4525	803	0	1	01	01	H4525_803_0	2		1	05/27/2014	2015.01	05/27/2014 05:28:10 PM Central Daylight Time	07/24/2014 03:15:05 PM Central Daylight Time				07/24/2014 05:36:15 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (HMO)	01	01		1			H4525	803	0	2015	FirstCare Advantage Employer		1	100	2			2							www.firstcare.com	www,firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										1	1	011100011000000001010100001100001000	2		1					1
H4525	804	0	1	01	01	H4525_804_0	2		1	05/27/2014	2015.01	05/27/2014 05:28:23 PM Central Daylight Time	07/24/2014 03:14:58 PM Central Daylight Time				07/24/2014 05:38:14 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (D) (HMO)	01	01		1			H4525	804	0	2015	FirstCare Advantage Employer (D)		1	100	2			2							www.firstcare.com	www,firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259		1	1	011100011000000001010100001100000100	2		1					1
H4525	805	0	1	01	01	H4525_805_0	2		1	05/27/2014	2015.01	05/27/2014 05:27:39 PM Central Daylight Time	07/24/2014 03:15:01 PM Central Daylight Time				07/24/2014 05:39:11 PM Central Daylight Time	SHA, L.L.C	FirstCare Advantage	www.firstcare.com/advantage	FirstCare Advantage Employer (HMO)	01	01		1			H4525	805	0	2015	FirstCare Advantage Employer		1	100	2			2							www.firstcare.com	www.firstcare.com/advantage	www.firstcare.com/advantage	(866)229-4969		(866)229-4969		(866)245-1580		(866)245-1580										(800)562-5259		(800)562-5259		(800)562-5259		(800)562-5259										1	1	011100010000000001010100001100000100	2		1					1
H4527	001	0	1	01	01	H4527_001_0	3		1	07/18/2014	2015.02	07/18/2014 03:05:35 PM Central Daylight Time	08/04/2014 04:41:12 PM Central Daylight Time	07/31/2014 03:19:02 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	001	0	2015	Aransas, Kleberg, Nueces, San Patricio counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	002	0	1	01	01	H4527_002_0	2		1	05/31/2014	2015.02	05/31/2014 12:40:30 AM Central Daylight Time	08/04/2014 04:42:19 PM Central Daylight Time	07/31/2014 03:22:01 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	002	0	2015	Hays, Travis, and Williamson counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	003	0	1	01	01	H4527_003_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:03:24 AM Central Daylight Time	08/04/2014 04:44:12 PM Central Daylight Time	07/31/2014 03:22:05 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	003	0	2015	Hays, Travis and Williamson counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	004	0	1	01	01	H4527_004_0	3	2	1	07/18/2014	2015.02	07/18/2014 08:41:54 AM Central Daylight Time	08/04/2014 04:45:07 PM Central Daylight Time	07/31/2014 03:22:09 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	004	0	2015	Aransas, Kleberg, Nueces, San Patricio counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	005	0	1	01	01	H4527_005_0	4		1	07/18/2014	2015.02	07/18/2014 03:05:42 PM Central Daylight Time	08/04/2014 04:46:11 PM Central Daylight Time	07/31/2014 03:22:12 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	005	0	2015	El Paso County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	006	0	1	01	01	H4527_006_0	4	2	1	07/18/2014	2015.02	07/18/2014 08:42:10 AM Central Daylight Time	08/04/2014 04:47:02 PM Central Daylight Time	07/31/2014 03:22:16 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	006	0	2015	El Paso County		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	013	0	1	01	01	H4527_013_0	3		1	07/18/2014	2015.02	07/18/2014 03:05:48 PM Central Daylight Time	08/04/2014 04:47:51 PM Central Daylight Time	07/31/2014 03:22:19 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus (HMO)	01	01		1			H4527	013	0	2015	Cameron, Hidalgo, and Willacy counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	015	0	1	01	01	H4527_015_0	4	2	1	07/18/2014	2015.02	07/18/2014 08:42:42 AM Central Daylight Time	08/04/2014 04:48:32 PM Central Daylight Time	07/31/2014 03:22:23 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.UHCMedicareSolutions.com	UnitedHealthcare Dual Complete Focus (HMO SNP)	01	01		1			H4527	015	0	2015	Cameron, Hidalgo, and Willacy counties		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(866)550-4736		(866)550-4736		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4527	024	0	1	01	01	H4527_024_0	1		1	05/14/2014	2015.02	05/14/2014 08:46:31 AM Central Daylight Time	05/30/2014 06:07:37 PM Central Daylight Time				05/31/2014 11:30:54 AM Central Daylight Time	PHYSICIANS HEALTH CHOICE OF TEXAS LLC	PHYSICIANS HEALTH CHOICE	www.AARPMedicarePlans.com	AARP MedicareComplete Focus Essential (HMO)	01	01		1			H4527	024	0	2015	Select counties in Texas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)550-4736		(866)550-4736		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H4528	001	0	1	01	01	H4528_001_0	5		1	07/16/2014	2015.02	07/16/2014 03:11:29 PM Central Daylight Time	05/30/2014 08:03:51 AM Central Daylight Time	07/31/2014 03:59:37 PM Central Daylight Time			08/05/2014 11:09:09 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H4528	001	0	2015	Select Texas Counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4528	002	0	1	01	01	H4528_002_0	6	2	1	07/16/2014	2015.02	07/16/2014 03:08:32 PM Central Daylight Time	08/04/2014 08:17:38 AM Central Daylight Time	07/31/2014 03:59:47 PM Central Daylight Time			08/05/2014 11:09:09 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H4528	002	0	2015	Select Texas Counties		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4564	001	0	1	18	06	H4564_001_0	2		1	07/14/2014	2015.01	07/14/2014 10:51:31 AM Central Daylight Time		07/11/2014 04:44:02 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium - Basic Rx (Cost)	06	18		1			H4564	001	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	002	0	1	18	06	H4564_002_0	2		1	07/14/2014	2015.01	07/14/2014 11:07:44 AM Central Daylight Time		07/11/2014 04:45:34 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred - Basic Rx (Cost)	06	18		1			H4564	002	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	003	0	1	18	06	H4564_003_0	2		1	07/14/2014	2015.01	07/14/2014 11:16:31 AM Central Daylight Time		07/11/2014 04:46:18 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Select - Basic Rx (Cost)	06	18		1			H4564	003	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	004	0	1	18	06	H4564_004_0	2		1	07/07/2014	2015.01	07/07/2014 04:55:09 PM Central Daylight Time		07/11/2014 04:49:04 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium - Enhanced Rx (Cost)	06	18		1			H4564	004	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	005	0	1	18	06	H4564_005_0	2		1	07/07/2014	2015.01	07/07/2014 04:55:20 PM Central Daylight Time		07/11/2014 04:49:58 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred - Enhanced Rx (Cost)	06	18		1			H4564	005	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	006	0	1	18	06	H4564_006_0	3		1	07/15/2014	2015.01	07/15/2014 11:41:42 AM Central Daylight Time		07/11/2014 04:51:36 PM Central Daylight Time			07/15/2014 11:49:17 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Select - Enhanced Rx (Cost)	06	18		1			H4564	006	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	010	0	1	18	06	H4564_010_0	2		1	07/07/2014	2015.01	07/07/2014 04:56:10 PM Central Daylight Time					07/15/2014 11:49:17 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium-Medical Only (Cost)	06	18		1			H4564	010	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2
H4564	011	0	1	18	06	H4564_011_0	2		1	07/07/2014	2015.01	07/07/2014 04:56:24 PM Central Daylight Time					07/15/2014 11:49:17 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred-Medical Only (Cost)	06	18		1			H4564	011	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2
H4564	012	0	1	18	06	H4564_012_0	3		1	07/17/2014	2015.01	07/17/2014 06:54:49 PM Central Daylight Time					07/17/2014 06:56:07 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Select-Medical Only (Cost)	06	18		1			H4564	012	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2
H4564	013	0	1	18	06	H4564_013_0	2		1	07/14/2014	2015.01	07/14/2014 01:58:48 PM Central Daylight Time		07/11/2014 05:04:22 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Premium - Value Rx (Cost)	06	18		1			H4564	013	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	014	0	1	18	06	H4564_014_0	2		1	07/14/2014	2015.01	07/14/2014 01:58:06 PM Central Daylight Time		07/11/2014 05:04:54 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Preferred - Value Rx (Cost)	06	18		1			H4564	014	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	015	0	1	18	06	H4564_015_0	3		1	07/15/2014	2015.01	07/15/2014 11:42:02 AM Central Daylight Time		07/11/2014 05:05:36 PM Central Daylight Time			07/15/2014 11:49:17 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr Select - Value Rx (Cost)	06	18		1			H4564	015	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	016	0	1	18	06	H4564_016_0	2		1	07/07/2014	2015.01	07/07/2014 04:57:53 PM Central Daylight Time					07/15/2014 11:49:17 AM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Medical Only (Cost)	06	18		1			H4564	016	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366										(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989										2					2					2
H4564	017	0	1	18	06	H4564_017_0	2		1	07/07/2014	2015.01	07/07/2014 04:58:02 PM Central Daylight Time		07/11/2014 04:47:26 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Basic Rx (Cost)	06	18		1			H4564	017	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	018	0	1	18	06	H4564_018_0	2		1	07/07/2014	2015.01	07/07/2014 04:58:08 PM Central Daylight Time		07/11/2014 04:52:10 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Enhanced Rx (Cost)	06	18		1			H4564	018	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	019	0	1	18	06	H4564_019_0	2		1	07/14/2014	2015.01	07/14/2014 02:08:08 PM Central Daylight Time		07/11/2014 05:06:06 PM Central Daylight Time			07/14/2014 04:45:16 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare Sr VIP - Value Rx (Cost)	06	18		1			H4564	019	0	2015	Central Texas		2		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H4564	801	0	1	18	06	H4564_801_0	1		1	05/21/2014	2015.01	05/21/2014 02:58:44 PM Central Daylight Time					06/02/2014 07:25:00 PM Central Daylight Time	SCOTT AND WHITE HEALTH PLAN	Scott and White Health Plan SeniorCare	www.swhp.org	SeniorCare EGWP (Cost)	06	18		1			H4564	801	0	2015	Central Texas		1		2			2								www.swhp.org	www.swhp.org	(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(866)334-3141		(254)298-3141		(800)782-5068		(254)298-3366		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989												
H4590	010	0	1	01	01	H4590_010_0	2		1	05/21/2014	2015.02	05/21/2014 02:58:57 PM Central Daylight Time	08/04/2014 02:51:13 PM Central Daylight Time	07/31/2014 03:22:26 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	010	0	2015	San Antonio area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	012	0	1	01	01	H4590_012_0	2		1	05/26/2014	2015.02	05/26/2014 02:10:03 PM Central Daylight Time	08/04/2014 02:51:30 PM Central Daylight Time	07/31/2014 03:22:29 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	012	0	2015	Dallas/Fort Worth Metroplex		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	020	0	1	01	01	H4590_020_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:04:25 AM Central Daylight Time	08/04/2014 04:03:49 PM Central Daylight Time	07/31/2014 03:22:33 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	020	0	2015	Dallas and Fort Worth metro areas		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	022	0	1	01	01	H4590_022_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:04:37 AM Central Daylight Time	08/12/2014 09:39:07 AM Central Daylight Time	07/31/2014 03:22:37 PM Central Daylight Time			08/12/2014 02:49:26 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	022	0	2015	San Antonio metro area		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	025	0	1	01	01	H4590_025_0	2		1	05/19/2014	2015.02	05/19/2014 08:14:30 AM Central Daylight Time	08/04/2014 02:51:47 PM Central Daylight Time	07/31/2014 03:22:40 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons (HMO)	01	01		1			H4590	025	0	2015	Nueces and San Patricio counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	027	0	1	01	01	H4590_027_0	1		1	05/26/2014	2015.02	05/26/2014 02:12:49 PM Central Daylight Time	05/30/2014 05:50:18 PM Central Daylight Time				05/31/2014 11:30:54 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H4590	027	0	2015	Dallas/Ft Worth Metroplex		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H4590	029	0	1	01	01	H4590_029_0	1		1	05/19/2014	2015.02	05/19/2014 08:14:50 AM Central Daylight Time	05/30/2014 05:50:49 PM Central Daylight Time				05/31/2014 11:30:54 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete SecureHorizons Essential (HMO)	01	01		1			H4590	029	0	2015	San Antonio area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H4590	033	0	1	01	01	H4590_033_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:04:48 AM Central Daylight Time	08/04/2014 04:18:24 PM Central Daylight Time	07/31/2014 03:22:44 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4590	033	0	2015	Corpus Christi metro area		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	037	0	1	01	01	H4590_037_0	2		1	05/20/2014	2015.02	05/20/2014 10:34:19 AM Central Daylight Time	08/04/2014 04:21:16 PM Central Daylight Time	07/31/2014 03:22:47 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Chronic Complete (HMO SNP)	01	01		1			H4590	037	0	2015	San Antonio area		2		2			1	4		1		00011010000000000000		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	038	0	1	01	01	H4590_038_0	5		1	07/18/2014	2015.02	07/18/2014 09:35:19 AM Central Daylight Time	08/12/2014 09:49:44 AM Central Daylight Time	07/31/2014 03:22:51 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H4590	038	0	2015	Collin, Dallas, Denton, Ellis and Tarrant counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(866)846-2762		(866)846-2762		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4590	801	0	1	01	01	H4590_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:15:47 AM Central Daylight Time	05/30/2014 05:51:49 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	801	0	2015	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H4590	803	0	1	01	01	H4590_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:15:55 AM Central Daylight Time	05/30/2014 05:52:20 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	803	0	2015	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(877)714-0178		(877)714-0178		(800)643-4845		(800)643-4845		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H4590	804	0	1	01	01	H4590_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:16:07 AM Central Daylight Time	05/30/2014 05:52:50 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4590	804	0	2015	TX Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(877)714-0178		(877)714-0178		(800)643-4845		(800)643-4845		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H4604	003	0	1	01	01	H4604_003_0	4		1	05/30/2014	2015.02	05/30/2014 04:30:34 PM Central Daylight Time	08/04/2014 02:33:47 PM Central Daylight Time	07/31/2014 03:22:54 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H4604	003	0	2015	Select counties in Utah		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4604	005	0	1	01	01	H4604_005_0	2		1	05/21/2014	2015.02	05/21/2014 09:40:14 AM Central Daylight Time	05/30/2014 06:04:37 PM Central Daylight Time				05/31/2014 10:35:47 AM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H4604	005	0	2015	Select counties in Utah		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H4604	011	0	1	01	01	H4604_011_0	4		1	05/30/2014	2015.02	05/30/2014 04:30:45 PM Central Daylight Time	08/04/2014 02:34:59 PM Central Daylight Time	07/31/2014 03:22:57 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H4604	011	0	2015	Select counties in Utah		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4604	801	0	1	01	01	H4604_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:16:23 AM Central Daylight Time	05/30/2014 06:05:25 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	801	0	2015	Salt Lake and Surrounding Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4604	803	0	1	01	01	H4604_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:16:28 AM Central Daylight Time	05/30/2014 06:05:50 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	803	0	2015	Select Counties In UT		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H4604	805	0	1	01	01	H4604_805_0	1		1	05/22/2014	2015.01	05/22/2014 09:16:34 AM Central Daylight Time	05/30/2014 06:06:14 PM Central Daylight Time				05/31/2014 12:03:34 PM Central Daylight Time	UNITEDHEALTHCARE OF UTAH, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H4604	805	0	2015	Select counties in UT		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H4605	001	0	1	04	01	H4605_001_0	8		1	07/14/2014	2015.01	07/14/2014 02:31:09 PM Mountain Daylight Time	06/27/2014 02:13:44 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H4605	001	0	2015	Select Counties in Utah		2	1539	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H4605	002	0	1	04	01	H4605_002_0	9		1	07/14/2014	2015.01	07/14/2014 02:32:47 PM Mountain Daylight Time	08/05/2014 10:27:12 AM Pacific Daylight Time	08/01/2014 08:29:38 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H4605	002	0	2015	Select Counties in Utah		2	7446	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4605	004	0	1	04	01	H4605_004_0	9		1	07/14/2014	2015.01	07/14/2014 02:32:51 PM Mountain Daylight Time	08/05/2014 10:27:26 AM Pacific Daylight Time	08/01/2014 08:30:04 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx Enhanced (PPO)	01	04		1			H4605	004	0	2015	Select Counties in Utah		2	7900	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4605	801	0	1	04	01	H4605_801_0	8		1	07/09/2014	2015.01	07/09/2014 05:35:24 PM Mountain Daylight Time	06/27/2014 02:14:58 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H4605	801	0	2015	Nationwide except territories		1		2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										2					2					
H4605	802	0	1	04	01	H4605_802_0	8		1	07/09/2014	2015.01	07/09/2014 05:35:36 PM Mountain Daylight Time	06/30/2014 06:40:01 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H4605	802	0	2015	Nationwide except territories		1		2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4714	001	0	1	20	08	H4714_001_0	1		1	05/30/2014	2015.01	05/30/2014 10:59:30 AM Eastern Daylight Time		05/30/2014 11:31:12 AM Eastern Daylight Time			05/30/2014 11:36:20 AM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont, Inc.	www.pacesp.com	PACE of  the Southern Piedmont - Dual (PACE)	08	20		1			H4714	001	0	2015	PACE of  the Southern Piedmont - Dual		2		2			2								Not applicable	www.seniorscript.com									(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840												
H4714	002	0	1	20	08	H4714_002_0	1		1	05/30/2014	2015.01	05/30/2014 11:14:09 AM Eastern Daylight Time		05/30/2014 11:31:28 AM Eastern Daylight Time			05/30/2014 11:36:20 AM Eastern Daylight Time	PACE OF THE SOUTHERN PIEDMONT, INC.	PACE of the Southern Piedmont, Inc.	www.pacesp.com	PACE of  the Southern Piedmont - Medicare only (PACE)	08	20		1			H4714	002	0	2015	PACE of  the Southern Piedmont - Medicare only		2		2			2								Not applicable	www.seniorscript.com									(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840										(704)887-3840		(704)887-3840		(704)887-3840		(704)887-3840												
H4738	002	0	1	04	01	H4738_002_0	8		1	07/18/2014	2015.01	07/18/2014 01:18:36 PM Eastern Daylight Time	08/04/2014 03:20:50 PM Eastern Daylight Time	08/04/2014 12:50:48 PM Eastern Daylight Time			08/05/2014 10:52:24 AM Eastern Daylight Time	AMERICA'S 1ST CHOICE HEALTH PLANS, INC.	America's 1st Choice Health Plans, Inc.	www.Americas1stChoice.com	Ambassador Plus (PPO)	01	04		1			H4738	002	0	2015	Select Counties in SC		2	1	2			2							www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		2					2					2
H4740	001	0	1	48	05	H4740_001_0	7		1	07/23/2014	2015.01	07/23/2014 02:50:07 PM Eastern Daylight Time					07/23/2014 02:50:57 PM Eastern Daylight Time	CATHOLIC MANAGED LONG TERM CARE, INC.	ArchCare Community Advantage	www.archcarecommunityadvantage.org	ArchCare Community Advantage FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H4740	001	0	2015	Kings, Queens, Bronx, NY, Richmond, Westchester		2	500	2			2							www.archcarecommunityadvantage.org	www.archcarecommunityadvantage.org	www.archcarecommunityadvantage.org	(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)373-3177		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4754	004	0	1	04	01	H4754_004_0	7		1	07/09/2014	2015.01	07/09/2014 12:34:33 PM Pacific Daylight Time	08/01/2014 04:38:12 PM Pacific Daylight Time	08/04/2014 08:56:41 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 4 (PPO)	01	04		1			H4754	004	0	2015	Lane County		2	1170	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					
H4754	006	0	1	04	01	H4754_006_0	8		1	07/09/2014	2015.01	07/09/2014 12:34:48 PM Pacific Daylight Time	07/15/2014 04:31:25 PM Pacific Daylight Time				07/17/2014 03:30:10 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 6 (PPO)	01	04		1			H4754	006	0	2015	Southwestern Idaho		2	1179	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					
H4754	007	0	1	04	01	H4754_007_0	7		1	07/09/2014	2015.01	07/09/2014 12:35:04 PM Pacific Daylight Time	08/01/2014 04:42:06 PM Pacific Daylight Time	08/04/2014 08:56:41 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 7 (PPO)	01	04		1			H4754	007	0	2015	Southwestern Oregon		2	407	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					
H4754	008	0	1	04	01	H4754_008_0	8		1	07/09/2014	2015.01	07/09/2014 12:35:19 PM Pacific Daylight Time	07/16/2014 07:51:24 AM Pacific Daylight Time				07/17/2014 03:30:10 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 8 (PPO)	01	04		1			H4754	008	0	2015	Southwestern Oregon		2	238	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)225-3771		(888)863-3637		(541)225-3771										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					
H4754	009	0	1	04	01	H4754_009_0	7		1	07/09/2014	2015.01	07/09/2014 12:35:35 PM Pacific Daylight Time	08/01/2014 04:46:09 PM Pacific Daylight Time	08/04/2014 08:56:41 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 9 (PPO)	01	04		1			H4754	009	0	2015	Eastern Idaho		2	3177	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					
H4754	010	0	1	04	01	H4754_010_0	8		1	07/09/2014	2015.01	07/09/2014 12:35:51 PM Pacific Daylight Time	07/15/2014 05:34:10 PM Pacific Daylight Time				07/17/2014 03:30:10 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 10 (PPO)	01	04		1			H4754	010	0	2015	Eastern Idaho		2	227	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					
H4754	011	0	1	04	01	H4754_011_0	7		1	07/09/2014	2015.01	07/09/2014 12:36:10 PM Pacific Daylight Time	08/01/2014 04:50:15 PM Pacific Daylight Time	08/04/2014 08:56:41 AM Pacific Daylight Time			08/04/2014 04:17:09 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 11 (PPO)	01	04		1			H4754	011	0	2015	Northern Idaho		2	3151	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					
H4754	012	0	1	04	01	H4754_012_0	8		1	07/09/2014	2015.01	07/09/2014 12:36:27 PM Pacific Daylight Time	07/15/2014 04:53:17 PM Pacific Daylight Time				07/17/2014 03:30:10 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 12 (PPO)	01	04		1			H4754	012	0	2015	Northern Idaho		2	438	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(208)433-4612		(888)863-3637		(208)433-4612										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										2					2					
H4754	801	0	1	04	01	H4754_801_0	5		1	06/01/2014	2015.01	06/01/2014 08:55:16 AM Pacific Daylight Time	06/04/2014 09:03:34 AM Pacific Daylight Time				06/04/2014 11:39:17 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer 801 (PPO)	01	04		1			H4754	801	0	2015	Statewide - Oregon and Idaho		1	100	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900										1	1	011100011011001011111110011100000100	2		1					
H4754	802	0	1	04	01	H4754_802_0	5		1	06/01/2014	2015.01	06/01/2014 08:55:45 AM Pacific Daylight Time	06/04/2014 09:57:29 AM Pacific Daylight Time				06/04/2014 11:39:17 AM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare Explorer Rx 802 (PPO)	01	04		1			H4754	802	0	2015	Statewide - Oregon and Idaho		1	100	2			2							http://medicare.pacificsource.com/Tools/ProviderDirectory.aspx	http://medicare.pacificsource.com/Tools/DrugSearch.aspx	https://medicare.pacificsource.com/Tools/PharmacySearch.aspx	(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		1	1	011100011011001011111110011100000100	2		1					
H4837	001	0	1	01	01	H4837_001_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:04:55 AM Central Daylight Time	08/04/2014 04:09:16 PM Central Daylight Time	07/31/2014 03:23:01 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare Community Plan	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H4837	001	0	2015	Milwaukee County		2		2			1	3		1	3		2	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	www.UHCCommunityPlan.com	(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(800)396-1942		(800)396-1942		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4866	002	0	1	01	01	H4866_002_0	11		1	08/05/2014	2015.02	08/05/2014 04:11:51 PM Central Daylight Time	08/05/2014 01:38:50 PM Central Daylight Time	08/05/2014 02:40:02 PM Central Daylight Time			08/06/2014 09:26:05 AM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Platinum (HMO)	01	01		1			H4866	002	0	2015	Access Medicare -Manhattan, Bronx, Queens Counties		2	2417	1	1		2							www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)391-1120		(646)216-3050		(877)696-1116		(646)216-3050		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4866	003	0	1	01	01	H4866_003_0	11		1	07/21/2014	2015.02	07/21/2014 11:04:27 AM Central Daylight Time	08/05/2014 01:39:50 PM Central Daylight Time	08/05/2014 02:41:25 PM Central Daylight Time			08/06/2014 09:26:05 AM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Gold (HMO)	01	01		1			H4866	003	0	2015	Access Medicare-Manhattan, Bronx, Queens Counties		2	1139	2			2							www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)391-1120		(646)216-3050		(877)696-1116		(646)216-3050		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4866	005	0	1	01	01	H4866_005_0	11	2	1	08/05/2014	2015.02	08/05/2014 04:12:13 PM Central Daylight Time	08/05/2014 01:41:00 PM Central Daylight Time	08/05/2014 02:40:57 PM Central Daylight Time			08/06/2014 09:26:05 AM Central Daylight Time	CUATRO LLC	Access Medicare	www.accessmedicareny.com	Access Medicare Pearl (HMO SNP)	01	01		1			H4866	005	0	2015	Access Medicare-Manhattan, Bronx, Queens Counties		2	1611	1	1		1	3		1	3		1	www.accessmedicareny.com	www.accessmedicareny.com	www.accessmedicareny.com	(877)696-1121		(646)216-3050		(877)696-1116		(646)216-3050		(877)391-1120		(646)216-3050		(877)696-1116		(646)216-3050		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4875	016	1	1	04	01	H4875_016_1	7		1	07/21/2014	2015.02	07/21/2014 11:24:28 AM Eastern Daylight Time	08/01/2014 05:53:56 PM Eastern Daylight Time	08/01/2014 09:28:58 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	1	2015	68 lower peninsula Michigan counties	MI counties: 4 southeast, 9 north and 4 mid-MI	2	2050	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	016	2	1	04	01	H4875_016_2	5		1	07/21/2014	2015.02	07/21/2014 11:24:46 AM Eastern Daylight Time	08/01/2014 05:54:04 PM Eastern Daylight Time	08/01/2014 09:29:34 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	2	2015	68 lower peninsula Michigan counties	MI counties: 3 SE, 3 SW, 6 NE, 2 NW and 3 mid-MI	2	4596	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	016	3	1	04	01	H4875_016_3	5		1	07/21/2014	2015.02	07/21/2014 11:25:12 AM Eastern Daylight Time	08/01/2014 05:54:12 PM Eastern Daylight Time	08/01/2014 09:29:42 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	3	2015	68 lower peninsula Michigan counties	MI counties: 11 east and 1 SW	2	2050	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	016	4	1	04	01	H4875_016_4	5		1	07/21/2014	2015.02	07/21/2014 11:25:25 AM Eastern Daylight Time	08/04/2014 08:47:56 AM Eastern Daylight Time	08/01/2014 09:29:50 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	4	2015	68 lower peninsula Michigan counties	MI counties: AG, BR, KN, LN, NW, OW	2	1535	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	016	5	1	04	01	H4875_016_5	5		1	07/21/2014	2015.02	07/21/2014 11:25:36 AM Eastern Daylight Time	08/04/2014 08:48:22 AM Eastern Daylight Time	08/01/2014 09:29:58 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Merit (PPO)	01	04		1			H4875	016	5	2015	68 lower peninsula Michigan counties	MI counties: 7 west, 6 mid-MI, 2 north and 1 east	2	1022	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	017	1	1	04	01	H4875_017_1	7		1	07/21/2014	2015.02	07/21/2014 11:25:48 AM Eastern Daylight Time	08/01/2014 05:54:36 PM Eastern Daylight Time	08/01/2014 09:30:08 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	1	2015	68 lower peninsula Michigan counties	MI counties: AG, BR, KN, LN, NW, OW	2	1865	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	017	2	1	04	01	H4875_017_2	5		1	07/21/2014	2015.02	07/21/2014 11:25:59 AM Eastern Daylight Time	08/01/2014 05:54:44 PM Eastern Daylight Time	08/01/2014 09:30:18 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	2	2015	68 lower peninsula Michigan counties	MI counties: 7 west, 6 mid-MI, 2 north and 1 east	2	1151	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	017	3	1	04	01	H4875_017_3	5		1	07/21/2014	2015.02	07/21/2014 11:26:10 AM Eastern Daylight Time	08/01/2014 05:54:52 PM Eastern Daylight Time	08/01/2014 09:30:26 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	3	2015	68 lower peninsula Michigan counties	MI counties: 4 southeast, 9 north and 4 mid-MI	2	664	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	017	4	1	04	01	H4875_017_4	5		1	07/21/2014	2015.02	07/21/2014 11:26:21 AM Eastern Daylight Time	08/01/2014 05:54:58 PM Eastern Daylight Time	08/01/2014 09:30:36 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	4	2015	68 lower peninsula Michigan counties	MI counties: 3 SE, 3 SW, 6 NE, 2 NW and 3 mid-MI	2	357	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	017	5	1	04	01	H4875_017_5	5		1	07/21/2014	2015.02	07/21/2014 11:26:31 AM Eastern Daylight Time	08/01/2014 05:55:06 PM Eastern Daylight Time	08/01/2014 09:30:46 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select (PPO)	01	04		1			H4875	017	5	2015	68 lower peninsula Michigan counties	MI counties: 11 east and 1 SW	2	495	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	018	1	1	04	01	H4875_018_1	7		1	07/21/2014	2015.02	07/21/2014 11:26:41 AM Eastern Daylight Time	08/04/2014 08:42:02 AM Eastern Daylight Time	08/01/2014 09:30:54 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	1	2015	68 lower peninsula Michigan counties	MI counties: AG, BR, KN, LN, NW, OW	2	30	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	018	2	1	04	01	H4875_018_2	6		1	07/21/2014	2015.02	07/21/2014 11:27:00 AM Eastern Daylight Time	08/04/2014 08:42:24 AM Eastern Daylight Time	08/01/2014 09:31:04 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	2	2015	68 lower peninsula Michigan counties	MI counties: 7 west, 6 mid-MI, 2 north and 1 east	2	131	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	018	3	1	04	01	H4875_018_3	6		1	07/21/2014	2015.02	07/21/2014 11:27:11 AM Eastern Daylight Time	08/04/2014 08:42:46 AM Eastern Daylight Time	08/01/2014 09:31:14 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	3	2015	68 lower peninsula Michigan counties	MI counties: 4 southeast, 9 north and 4 mid-MI	2	147	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	018	4	1	04	01	H4875_018_4	6		1	07/21/2014	2015.02	07/21/2014 11:27:21 AM Eastern Daylight Time	08/04/2014 08:43:10 AM Eastern Daylight Time	08/01/2014 09:31:24 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	4	2015	68 lower peninsula Michigan counties	MI counties: 3 SE, 3 SW, 6 NE, 2 NW and 3 mid-MI	2	147	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	018	5	1	04	01	H4875_018_5	6		1	07/21/2014	2015.02	07/21/2014 11:27:31 AM Eastern Daylight Time	08/04/2014 08:43:36 AM Eastern Daylight Time	08/01/2014 09:31:34 AM Eastern Daylight Time			08/05/2014 05:27:10 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Ideal (PPO)	01	04		1			H4875	018	5	2015	68 lower peninsula Michigan counties	MI counties: 11 east and 1 SW	2	668	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	803	0	1	04	01	H4875_803_0	4		1	07/21/2014	2015.02	07/21/2014 11:28:14 AM Eastern Daylight Time	07/17/2014 11:47:28 AM Eastern Daylight Time				07/21/2014 12:27:06 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select EG Non-Calendar Year (PPO)	01	04		1			H4875	803	0	2015	National		1	4	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4875	804	0	1	04	01	H4875_804_0	4		1	07/21/2014	2015.02	07/21/2014 11:28:26 AM Eastern Daylight Time	07/17/2014 11:47:28 AM Eastern Daylight Time				07/21/2014 12:27:06 PM Eastern Daylight Time	PRIORITY HEALTH	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Select EG Calendar Year (PPO)	01	04		1			H4875	804	0	2015	National		1	4	2			2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com	(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4876	001	0	1	04	01	H4876_001_0	8		1	08/06/2014	2015.01	08/06/2014 09:25:10 AM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time			08/06/2014 02:20:02 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Olympus - Constellation Health (PPO)	01	04		1			H4876	001	0	2015	Puerto Rico		2	645	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					
H4876	801	0	1	04	01	H4876_801_0	4		1	07/18/2014	2015.01	07/18/2014 11:12:33 AM SA Western Standard Time	06/01/2014 08:52:18 PM SA Western Standard Time				07/18/2014 11:16:17 AM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Geminis 1 - Constellation Health (PPO)	01	04		1			H4876	801	0	2015	Puerto Rico		1	750	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		1	1	011100000000000001111000001100000000	2		1					
H4876	802	0	1	04	01	H4876_802_0	4		1	07/18/2014	2015.01	07/18/2014 11:12:09 AM SA Western Standard Time	06/01/2014 08:52:18 PM SA Western Standard Time				07/18/2014 11:18:28 AM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Geminis 2 - Constellation Health (PPO)	01	04		1			H4876	802	0	2015	Puerto Rico		1	1150	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		1	1	011000000000000001111110001100000000	2		1					
H4909	014	0	1	04	01	H4909_014_0	14		1	07/30/2014	2015.01	07/30/2014 10:13:50 AM Pacific Daylight Time	08/05/2014 11:52:36 PM Pacific Daylight Time	08/01/2014 02:31:07 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Core (PPO)	01	04		1			H4909	014	0	2015	Mathews County		2	122	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)827-9866		(866)827-9866		(800)797-5937		(800)797-5937		(866)827-9866		(866)827-9866		(800)797-5937		(800)797-5937		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H4909	804	0	1	04	01	H4909_804_0	6		1	05/30/2014	2015.01	05/30/2014 03:09:55 PM Pacific Daylight Time	07/15/2014 03:54:11 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	804	0	2015	Virginia		1	2312	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H4909	805	0	1	04	01	H4909_805_0	6		1	05/30/2014	2015.01	05/30/2014 03:09:59 PM Pacific Daylight Time	07/15/2014 03:54:30 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	805	0	2015	Virginia		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H4909	806	0	1	04	01	H4909_806_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:03 PM Pacific Daylight Time	07/15/2014 03:54:38 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF VIRGINIA, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H4909	806	0	2015	Virginia		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H4910	005	0	1	01	01	H4910_005_0	6		1	08/02/2014	2015.01	08/02/2014 02:11:24 PM Eastern Daylight Time	08/05/2014 02:50:24 PM Eastern Daylight Time	08/01/2014 10:00:27 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Innovation Prime Plan (HMO)	01	01		1			H4910	005	0	2015	Fairfax County and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4910	801	0	1	01	01	H4910_801_0	2		1	05/23/2014	2015.01	05/23/2014 01:45:11 PM Eastern Daylight Time	07/24/2014 03:34:17 PM Eastern Daylight Time				07/24/2014 03:45:20 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H4910	801	0	2015	Virginia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H4910	802	0	1	01	01	H4910_802_0	2		1	05/23/2014	2015.01	05/23/2014 01:47:47 PM Eastern Daylight Time	07/25/2014 10:09:44 AM Eastern Daylight Time				07/25/2014 10:35:08 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H4910	802	0	2015	Virginia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H4922	001	0	1	01	01	H4922_001_0	7		1	07/10/2014	2015.01	07/10/2014 04:08:21 PM Eastern Daylight Time	07/01/2014 03:06:15 PM Eastern Daylight Time	07/01/2014 03:17:34 PM Eastern Daylight Time			07/10/2014 04:10:49 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	LiveWell (HMO)	01	01		1			H4922	001	0	2015	New York City Metro Area, Long Island, Westchester		2	1000	2			2							http://www.agewellnewyork.com/provider-list/	http://www.agewellnewyork.com/	http://www.agewellnewyork.com/	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4922	002	0	1	01	01	H4922_002_0	11	2	1	08/06/2014	2015.01	08/06/2014 11:29:00 AM Eastern Daylight Time	08/06/2014 12:11:46 PM Eastern Daylight Time	08/06/2014 12:11:46 PM Eastern Daylight Time			08/06/2014 12:14:46 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	BeWell (HMO SNP)	01	01		1			H4922	002	0	2015	New York City Metro Area, Long Island, Westchester		2	175	2			1	3		1	5			http://www.agewellnewyork.com/provider-list/	http://www.agewellnewyork.com/	http://www.agewellnewyork.com/	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4922	003	0	1	01	01	H4922_003_0	11	2	1	08/06/2014	2015.01	08/06/2014 11:29:13 AM Eastern Daylight Time	08/06/2014 12:11:46 PM Eastern Daylight Time	08/06/2014 12:11:46 PM Eastern Daylight Time			08/06/2014 12:14:46 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	FeelWell (HMO SNP)	01	01		1			H4922	003	0	2015	New York City Metro Area, Long Island, Westchester		2	650	2			1	3		1	2			http://www.agewellnewyork.com/provider-list/	http://www.agewellnewyork.com/	http://www.agewellnewyork.com/	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4922	004	0	1	01	01	H4922_004_0	10		1	08/06/2014	2015.01	08/06/2014 11:29:25 AM Eastern Daylight Time	08/06/2014 12:11:46 PM Eastern Daylight Time	08/06/2014 12:11:46 PM Eastern Daylight Time			08/06/2014 12:14:46 PM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	CareWell (HMO SNP)	01	01		1			H4922	004	0	2015	New York City Metro Area, Long Island, Westchester		2	190	2			1	1	1	1				http://www.agewellnewyork.com/provider-list/	http://www.agewellnewyork.com/	http://www.agewellnewyork.com/	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H4931	001	0	1	01	01	H4931_001_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:25:22 PM US Mountain Standard Time	08/05/2014 06:26:00 PM US Mountain Standard Time	08/05/2014 04:18:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	001	0	2015	Cochise County		2	496	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	002	0	1	01	01	H4931_002_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:39:25 PM US Mountain Standard Time	08/05/2014 06:35:00 PM US Mountain Standard Time	08/05/2014 04:19:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	002	0	2015	Gila County		2	10	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	003	0	1	01	01	H4931_003_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:43:00 PM US Mountain Standard Time	08/05/2014 06:40:00 PM US Mountain Standard Time	08/05/2014 04:21:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	003	0	2015	Graham County		2	56	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	004	0	1	01	01	H4931_004_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:47:26 PM US Mountain Standard Time	08/05/2014 06:52:00 PM US Mountain Standard Time	08/05/2014 04:22:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	004	0	2015	Greenlee County		2	15	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	005	0	1	01	01	H4931_005_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:50:24 PM US Mountain Standard Time	08/05/2014 06:57:00 PM US Mountain Standard Time	08/05/2014 04:24:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	005	0	2015	La Paz County		2	10	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	006	0	1	01	01	H4931_006_0	4	2	1	08/05/2014	2015.01	08/05/2014 03:54:50 PM US Mountain Standard Time	08/05/2014 06:54:00 PM US Mountain Standard Time	08/05/2014 04:25:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	006	0	2015	Pima County		2	1411	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	007	0	1	01	01	H4931_007_0	4	2	1	08/05/2014	2015.01	08/05/2014 04:22:24 PM US Mountain Standard Time	08/05/2014 06:59:00 PM US Mountain Standard Time	08/05/2014 04:29:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	007	0	2015	Pinal County		2	618	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	008	0	1	01	01	H4931_008_0	4	2	1	08/05/2014	2015.01	08/05/2014 04:28:11 PM US Mountain Standard Time	08/05/2014 07:04:00 PM US Mountain Standard Time	08/05/2014 04:31:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	008	0	2015	Santa Cruz County		2	281	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	009	0	1	01	01	H4931_009_0	4	2	1	08/05/2014	2015.01	08/05/2014 04:31:07 PM US Mountain Standard Time	08/05/2014 07:06:00 PM US Mountain Standard Time	08/05/2014 04:32:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	009	0	2015	Yavapai County		2	441	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4931	010	0	1	01	01	H4931_010_0	4	2	1	08/05/2014	2015.01	08/05/2014 04:42:05 PM US Mountain Standard Time	08/05/2014 07:08:00 PM US Mountain Standard Time	08/05/2014 04:34:00 PM US Mountain Standard Time			08/06/2014 05:10:56 PM US Mountain Standard Time	UNIVERSITY CARE ADVANTAGE, INC.	University Care Advantage	http://www.universitycareadvantage.com/	University Care Advantage (HMO SNP)	01	01		1			H4931	010	0	2015	Yuma County		2	282	2			1	3		1	3		1	http://www.universitycareadvantage.com/ProviderSearch.aspx	http://www.universitycareadvantage.com/PartDResources.aspx	http://www.universitycareadvantage.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H4999	001	0	1	20	08	H4999_001_0	1		1	05/30/2014	2015.01	05/30/2014 09:51:50 AM Eastern Daylight Time		05/17/2014 02:50:45 PM Eastern Daylight Time			05/30/2014 09:54:39 AM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	001	0	2015	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2								www.lifenwpa.org	www.lifenwpa.org									(800)456-5433		(814)456-5433		(800)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433												
H4999	002	0	1	20	08	H4999_002_0	1		1	05/30/2014	2015.01	05/30/2014 09:52:26 AM Eastern Daylight Time		05/17/2014 03:08:18 PM Eastern Daylight Time			05/30/2014 09:54:39 AM Eastern Daylight Time	THE LUTHERAN HOME FOR THE AGED	LIFE Northwestern Pennsylvania	www.lifenwpa.org	LIFE Northwestern Pennsylvania (PACE)	08	20		1			H4999	002	0	2015	Counties: Erie, War, Craw, Mer, Ven, McK, For, Cla		2		2			2								www.lifenwpa.org	www.lifenwpa.org									(800)456-5433		(814)456-5433		(800)456-5433		(814)456-5433										(814)456-5433		(814)456-5433		(814)456-5433		(814)456-5433												
H5005	011	0	1	01	01	H5005_011_0	4		1	05/30/2014	2015.02	05/30/2014 04:31:01 PM Central Daylight Time	08/04/2014 02:32:15 PM Central Daylight Time	07/31/2014 03:23:05 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF WASHINGTON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H5005	011	0	2015	Select Counties in Western Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5005	019	0	1	01	01	H5005_019_0	4		1	05/30/2014	2015.02	05/30/2014 04:31:10 PM Central Daylight Time	08/04/2014 02:32:50 PM Central Daylight Time	07/31/2014 03:23:08 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	UNITEDHEALTHCARE OF WASHINGTON, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 3 (HMO)	01	01		1			H5005	019	0	2015	Select Counties in Western Washington		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(800)950-9355		(800)950-9355		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5005	801	0	1	01	01	H5005_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:16:42 AM Central Daylight Time	05/30/2014 04:41:56 PM Central Daylight Time				05/31/2014 12:07:05 PM Central Daylight Time	UNITEDHEALTHCARE OF WASHINGTON, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5005	801	0	2015	WA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H5005	803	0	1	01	01	H5005_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:16:48 AM Central Daylight Time	05/30/2014 04:42:21 PM Central Daylight Time				05/31/2014 12:07:05 PM Central Daylight Time	UNITEDHEALTHCARE OF WASHINGTON, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5005	803	0	2015	WA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H5005	804	0	1	01	01	H5005_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:17:01 AM Central Daylight Time	05/30/2014 04:42:46 PM Central Daylight Time				05/31/2014 12:07:05 PM Central Daylight Time	UNITEDHEALTHCARE OF WASHINGTON, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5005	804	0	2015	WA Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H5007	001	0	1	20	08	H5007_001_0	1		1	05/20/2014	2015.01	05/20/2014 10:14:00 AM Pacific Daylight Time		05/16/2014 06:53:44 PM Pacific Daylight Time			05/20/2014 10:17:52 AM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	08	20		1			H5007	001	0	2015	Seattle - King County Washington		2		2			2								www.providence.org/longtermcare/elderplace	www.providence.org/longtermcare/elderplace									(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325												
H5007	002	0	1	20	08	H5007_002_0	1		1	05/20/2014	2015.01	05/20/2014 10:14:51 AM Pacific Daylight Time		05/16/2014 08:02:30 PM Pacific Daylight Time			05/20/2014 10:17:52 AM Pacific Daylight Time	PROVIDENCE HEALTH SYSTEM	Providence Health System	washington.providence.org/senior-care/elderplace	Providence ElderPlace - Seattle (PACE)	08	20		1			H5007	002	0	2015	Seattle - King County Washington		2		2			2								www.providence.org/longtermcare/elderplace	www.providence.org/longtermcare/elderplace									(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325										(206)320-5325		(206)320-5325		(206)320-5325		(206)320-5325												
H5008	001	0	1	01	01	H5008_001_0	5		1	05/28/2014	2015.02	05/28/2014 04:16:20 PM Central Daylight Time	08/12/2014 09:41:30 AM Central Daylight Time	07/31/2014 03:23:12 PM Central Daylight Time			08/13/2014 09:17:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5008	001	0	2015	Northwest Washington and Spokane county		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5008	002	0	1	01	01	H5008_002_0	2	2	1	05/30/2014	2015.02	05/30/2014 11:05:07 AM Central Daylight Time	08/04/2014 04:10:37 PM Central Daylight Time	07/31/2014 03:23:15 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (HMO SNP)	01	01		1			H5008	002	0	2015	Seattle metro area and Spokane county		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5009	001	0	1	04	01	H5009_001_0	8		1	07/14/2014	2015.01	07/14/2014 02:31:28 PM Mountain Daylight Time	06/27/2014 02:15:50 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage Basic (PPO)	01	04		1			H5009	001	0	2015	Select Counties in Washington		2	11879	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-										2					2					
H5009	002	0	1	04	01	H5009_002_0	9		1	07/14/2014	2015.01	07/14/2014 02:33:42 PM Mountain Daylight Time	08/05/2014 10:27:38 AM Pacific Daylight Time	08/01/2014 08:30:26 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx Classic (PPO)	01	04		1			H5009	002	0	2015	Select Counties in Washington		2	11879	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5009	801	0	1	04	01	H5009_801_0	8		1	07/09/2014	2015.01	07/09/2014 05:35:53 PM Mountain Daylight Time	06/27/2014 02:16:43 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage (PPO)	01	04		1			H5009	801	0	2015	Nationwide except territories		1	3001	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-										2					2					
H5009	802	0	1	04	01	H5009_802_0	8		1	07/09/2014	2015.01	07/09/2014 05:36:03 PM Mountain Daylight Time	06/30/2014 06:40:31 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	REGENCE BLUESHIELD	Regence BlueShield	www.regence.com/medicare	Regence MedAdvantage + Rx (PPO)	01	04		1			H5009	802	0	2015	Nationwide except territories		1	2891	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5010	001	0	1	04	01	H5010_001_0	8		1	07/14/2014	2015.01	07/14/2014 02:31:30 PM Mountain Daylight Time	06/27/2014 02:17:36 PM Pacific Daylight Time				07/14/2014 04:29:38 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage Basic (PPO)	01	04		1			H5010	001	0	2015	Select Counties in Eastern Washington		2	916	2			2							www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-										2					2					
H5010	002	0	1	04	01	H5010_002_0	9		1	07/14/2014	2015.01	07/14/2014 02:33:54 PM Mountain Daylight Time	08/05/2014 10:27:50 AM Pacific Daylight Time	08/01/2014 08:30:52 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Classic (PPO)	01	04		1			H5010	002	0	2015	Select Counties in Eastern Washington		2	100	2			2							www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5010	004	0	1	04	01	H5010_004_0	9		1	07/14/2014	2015.01	07/14/2014 02:34:01 PM Mountain Daylight Time	08/05/2014 10:28:04 AM Pacific Daylight Time	08/01/2014 08:31:16 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris TruAdvantage + Rx Enhanced (PPO)	01	04		1			H5010	004	0	2015	Select Counties in Eastern Washington		2	100	2			2							www.asuris.com/medicare	www.asuris.com/medicare	www.asuris.com/medicare	(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5037	001	0	1	20	08	H5037_001_0	2		1	05/30/2014	2015.01	05/30/2014 10:41:17 AM Eastern Daylight Time		05/30/2014 10:33:00 AM Eastern Daylight Time			05/30/2014 10:43:32 AM Eastern Daylight Time	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE - Dual (PACE)	08	20		1			H5037	001	0	2015	Lee, Scott, Wise Counties and Norton City		2		2			2								www.meoc.org	www.meoc.org									(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599												
H5037	002	0	1	20	08	H5037_002_0	2		1	05/30/2014	2015.01	05/30/2014 10:41:33 AM Eastern Daylight Time		05/30/2014 10:33:00 AM Eastern Daylight Time			05/30/2014 10:43:32 AM Eastern Daylight Time	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	Mountain Empire PACE	www.meoc.org	Mountain Empire PACE  - Medicare only (PACE)	08	20		1			H5037	002	0	2015	Lee, Scott, Wise Counties and Norton City		2		2			2								www.meoc.org	www.meoc.org									(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599										(866)793-7223		(276)523-0599		(866)793-7223		(276)523-0599												
H5042	001	0	1	04	01	H5042_001_0	8		1	07/17/2014	2015.01	07/17/2014 03:31:40 PM Eastern Daylight Time	08/05/2014 11:02:19 AM Eastern Daylight Time	08/05/2014 11:02:19 AM Eastern Daylight Time			08/05/2014 11:22:16 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Classic Rx (PPO)	01	04		1			H5042	001	0	2015	Capital, Central, Southern Tier, Hudson Valley NY		2	1705	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					
H5042	004	0	1	04	01	H5042_004_0	5		1	07/17/2014	2015.01	07/17/2014 03:29:21 PM Eastern Daylight Time	05/30/2014 10:06:23 AM Eastern Daylight Time				07/17/2014 04:02:19 PM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Classic (PPO)	01	04		1			H5042	004	0	2015	Capital, Central, Southern Tier, Hudson Valley NY		2	96	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										2					2					
H5042	005	0	1	04	01	H5042_005_0	7		1	07/17/2014	2015.01	07/17/2014 03:30:20 PM Eastern Daylight Time	08/05/2014 11:02:20 AM Eastern Daylight Time	08/05/2014 11:02:20 AM Eastern Daylight Time			08/05/2014 11:22:16 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Core Rx (PPO)	01	04		1			H5042	005	0	2015	Capital, Central, Southern Tier, Hudson Valley NY		2	831	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					
H5042	007	0	1	04	01	H5042_007_0	10		1	07/17/2014	2015.01	07/17/2014 03:31:08 PM Eastern Daylight Time	08/05/2014 11:02:20 AM Eastern Daylight Time	08/05/2014 11:02:16 AM Eastern Daylight Time			08/05/2014 11:22:16 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Prime Rx (PPO)	01	04		1			H5042	007	0	2015	Capital, Central, Southern Tier, Hudson Valley NY		2	699	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(518)641-3950		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		2					2					
H5042	801	0	1	04	01	H5042_801_0	2		1	05/20/2014	2015.01	05/20/2014 06:07:10 PM Eastern Daylight Time	05/30/2014 10:06:24 AM Eastern Daylight Time				05/30/2014 10:27:59 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	801	0	2015	Upstate New York Region		1	82	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(888)831-3039		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	001100001000000000111000001100000100	1	011111000000000111000000100	1					
H5042	802	0	1	04	01	H5042_802_0	2		1	05/20/2014	2015.01	05/20/2014 06:07:16 PM Eastern Daylight Time	05/30/2014 10:06:25 AM Eastern Daylight Time				05/30/2014 10:27:59 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare Rx (PPO)	01	04		1			H5042	802	0	2015	Upstate New York Region		1	3344	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400		(888)831-3039		(888)831-3039		(888)519-4455		(518)641-3400		(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000		(866)236-1069		(518)641-4000		(877)261-1164		(518)641-4000		1	1	001100001000000000111000001100000100	1	011111000000000111000000100	1					
H5042	803	0	1	04	01	H5042_803_0	2		1	05/20/2014	2015.01	05/20/2014 06:07:24 PM Eastern Daylight Time	05/30/2014 10:06:12 AM Eastern Daylight Time				05/30/2014 10:27:59 AM Eastern Daylight Time	CDPHP UNIVERSAL BENEFITS, INC.	CDPHP Medicare Choices	http://www.CDPHP.com/medicare	CDPHP Group Medicare (PPO)	01	04		1			H5042	803	0	2015	Upstate New York Region		1	341	2			2							http://www.CDPHP.com/medicare	http://www.cdphp.com/medicare	http://www.cdphp.com/medicare	(888)248-6522		(518)641-3950		(888)519-4455		(518)641-3400										(877)261-1164		(518)641-4000		(877)261-1164		(518)641-4000										1	1	001100001000000000111000001100000100	1	011111000000000111000000100	1					
H5048	001	0	1	01	01	H5048_001_0	9		1	08/04/2014	2015.01	08/04/2014 06:51:25 AM Central Daylight Time	08/06/2014 08:17:32 AM Central Daylight Time	08/06/2014 02:18:20 PM Central Daylight Time			08/06/2014 02:21:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF TEXAS, INC.	Coventry Health Care of Texas, Inc.	http://www.tx.chcadvantra.com	Advantra (HMO)	01	01		1			H5048	001	0	2015	El Paso, Parker, Bowie		2	26	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693		(866)544-2965		(866)544-2965		(855)893-4693		(855)893-4693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5048	002	0	1	01	01	H5048_002_0	11		1	08/04/2014	2015.01	08/04/2014 06:52:58 AM Central Daylight Time	08/06/2014 08:17:34 AM Central Daylight Time	08/06/2014 02:18:20 PM Central Daylight Time			08/06/2014 02:21:34 PM Central Daylight Time	COVENTRY HEALTH CARE OF TEXAS, INC.	Coventry Health Care of Texas, Inc.	http://www.tx.chcadvantra.com	Advantra (HMO)	01	01		1			H5048	002	0	2015	Counties: BX, ME, NU, HA, FB, MO, JE		2	138	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693		(866)544-2965		(866)544-2965		(855)893-4693		(855)893-4693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5048	801	0	1	01	01	H5048_801_0	2		1	05/31/2014	2015.01	05/31/2014 08:55:35 AM Central Daylight Time	05/30/2014 10:34:04 PM Central Daylight Time				06/01/2014 11:48:26 AM Central Daylight Time	COVENTRY HEALTH CARE OF TEXAS, INC.	Coventry Health Care of Texas, Inc.	http://www.tx.chcadvantra.com	Advantra (HMO)	01	01		1			H5048	801	0	2015	Texas - Employer Group Plan CYD with RX		1		2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693		(866)544-2965		(866)544-2965		(855)893-4693		(855)893-4693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110110011111000000	2		1					1
H5048	803	0	1	01	01	H5048_803_0	2		1	05/23/2014	2015.01	05/23/2014 02:17:13 PM Central Daylight Time	05/30/2014 10:16:56 PM Central Daylight Time				06/01/2014 11:48:26 AM Central Daylight Time	COVENTRY HEALTH CARE OF TEXAS, INC.	Coventry Health Care of Texas, Inc.	http://www.tx.chcadvantra.com	Advantra (HMO)	01	01		1			H5048	803	0	2015	Texas Employer Group CYD No RX		1		2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100101110111011111000000	2		1					1
H5050	001	0	1	01	01	H5050_001_0	3		1	05/21/2014	2015.01	05/21/2014 09:26:23 AM Pacific Daylight Time	05/30/2014 02:32:54 PM Pacific Daylight Time				05/31/2014 02:49:56 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Basic (HMO)	01	01		1			H5050	001	0	2015	Puget Sound Area and Counties: GY, TH, LE, SP		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2
H5050	004	0	1	01	01	H5050_004_0	5		1	07/16/2014	2015.01	07/16/2014 12:29:35 PM Pacific Daylight Time	08/05/2014 09:04:21 AM Pacific Daylight Time	08/05/2014 09:08:11 AM Pacific Daylight Time			08/06/2014 10:17:16 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Optimal (HMO)	01	01		1			H5050	004	0	2015	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5050	009	0	1	01	01	H5050_009_0	4		1	05/29/2014	2015.01	05/29/2014 07:15:39 AM Pacific Daylight Time	08/05/2014 09:08:38 AM Pacific Daylight Time	08/05/2014 09:08:51 AM Pacific Daylight Time			08/06/2014 10:17:16 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Essential (HMO)	01	01		1			H5050	009	0	2015	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5050	013	0	1	01	01	H5050_013_0	4		1	05/29/2014	2015.01	05/29/2014 07:18:17 AM Pacific Daylight Time	08/05/2014 09:09:28 AM Pacific Daylight Time	08/05/2014 09:09:49 AM Pacific Daylight Time			08/06/2014 10:17:16 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Vital (HMO)	01	01		1			H5050	013	0	2015	Counties: KI, PI, KP, SN, GY, LE, MA, TH		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5050	017	0	1	01	01	H5050_017_0	5		1	05/31/2014	2015.01	05/31/2014 04:03:43 PM Pacific Daylight Time	08/05/2014 09:10:10 AM Pacific Daylight Time	08/05/2014 09:10:35 AM Pacific Daylight Time			08/06/2014 10:17:16 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Harbor (HMO)	01	01		1			H5050	017	0	2015	Counties: SK, SJ, IS, WM		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5050	018	0	1	01	01	H5050_018_0	4		1	05/29/2014	2015.01	05/29/2014 07:23:40 AM Pacific Daylight Time	08/05/2014 09:10:54 AM Pacific Daylight Time	08/05/2014 09:11:06 AM Pacific Daylight Time			08/06/2014 10:17:16 AM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Haven (HMO)	01	01		1			H5050	018	0	2015	Counties: SK, SJ, IS, WM		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5050	019	0	1	01	01	H5050_019_0	5		1	08/08/2014	2015.01	08/08/2014 12:34:34 PM Pacific Daylight Time	08/05/2014 09:11:21 AM Pacific Daylight Time	08/05/2014 09:11:31 AM Pacific Daylight Time			08/08/2014 01:46:51 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Cooperative Columbia (HMO)	01	01		1			H5050	019	0	2015	Spokane		2		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5050	801	0	1	01	01	H5050_801_0	3		1	05/23/2014	2015.01	05/23/2014 12:46:32 PM Pacific Daylight Time	05/30/2014 02:38:25 PM Pacific Daylight Time				05/31/2014 02:49:56 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Employer Group (HMO)	01	01		1			H5050	801	0	2015	Puget Sound Area and Counties: GY, TH, LE, SP		1		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882										(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388										2					2					2
H5050	802	0	1	01	01	H5050_802_0	3		1	05/28/2014	2015.01	05/28/2014 09:43:58 AM Pacific Daylight Time	05/30/2014 02:38:47 PM Pacific Daylight Time				05/31/2014 02:49:56 PM Pacific Daylight Time	GROUP HEALTH COOPERATIVE	Group Health Cooperative	www.ghc.org/medicare	Group Health Employer Group with Part D (HMO)	01	01		1			H5050	802	0	2015	Puget Sound Area and Counties: GY, TH, LE, SP		1		2			2							www.ghc.org/medicare	https://www1.ghc.org/medicare/formulary	www.ghc.org/medicare	(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(888)901-4600		(206)901-4600		(800)446-8882		(800)446-8882		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		(800)833-6388		2					2					2
H5087	001	0	1	01	01	H5087_001_0	8	2	1	07/24/2014	2015.02	07/24/2014 07:36:07 AM Eastern Daylight Time	08/05/2014 11:29:11 AM Eastern Daylight Time	08/01/2014 11:32:53 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Freedom Plan (HMO SNP)	01	01		1			H5087	001	0	2015	Los Angeles County		2	19724	2			1	3		1	3		1	www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	002	0	1	01	01	H5087_002_0	8		1	08/04/2014	2015.02	08/04/2014 08:49:18 PM Eastern Daylight Time	08/05/2014 11:29:24 AM Eastern Daylight Time	08/01/2014 11:33:04 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Plus Plan (HMO)	01	01		1			H5087	002	0	2015	OC, RIV, SD, SB, Alameda, San Joaquin, Stanislaus		2	6759	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	005	0	1	01	01	H5087_005_0	8		1	08/04/2014	2015.02	08/04/2014 08:49:49 PM Eastern Daylight Time	08/05/2014 11:29:37 AM Eastern Daylight Time	08/01/2014 11:33:15 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	005	0	2015	Los Angeles, Orange Counties		2	25509	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	010	0	1	01	01	H5087_010_0	8		1	08/04/2014	2015.02	08/04/2014 08:50:34 PM Eastern Daylight Time	08/05/2014 11:29:51 AM Eastern Daylight Time	08/01/2014 11:33:25 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Value Plan (HMO)	01	01		1			H5087	010	0	2015	Fresno, San Joaquin Counties		2	2982	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	011	0	1	01	01	H5087_011_0	8		1	08/04/2014	2015.02	08/04/2014 08:51:24 PM Eastern Daylight Time	08/05/2014 11:30:04 AM Eastern Daylight Time	08/01/2014 11:33:37 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	011	0	2015	Alameda County		2	1022	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	012	0	1	01	01	H5087_012_0	8		1	08/04/2014	2015.02	08/04/2014 08:52:15 PM Eastern Daylight Time	08/05/2014 11:30:18 AM Eastern Daylight Time	08/01/2014 11:33:47 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	012	0	2015	San Diego County		2	3517	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	014	0	1	01	01	H5087_014_0	8		1	08/04/2014	2015.02	08/04/2014 08:52:56 PM Eastern Daylight Time	08/05/2014 11:30:31 AM Eastern Daylight Time	08/01/2014 11:33:57 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	014	0	2015	Santa Clara County		2	1634	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	015	0	1	01	01	H5087_015_0	8		1	08/04/2014	2015.02	08/04/2014 08:53:37 PM Eastern Daylight Time	08/05/2014 11:30:45 AM Eastern Daylight Time	08/01/2014 11:34:08 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	015	0	2015	Stanislaus County		2	1337	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	016	0	1	01	01	H5087_016_0	8		1	08/04/2014	2015.02	08/04/2014 08:54:41 PM Eastern Daylight Time	08/05/2014 11:30:58 AM Eastern Daylight Time	08/01/2014 11:34:19 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Best Plan (HMO)	01	01		1			H5087	016	0	2015	Riverside, San Bernardino		2	464	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	017	0	1	01	01	H5087_017_0	8		1	07/24/2014	2015.02	07/24/2014 07:38:05 AM Eastern Daylight Time	08/05/2014 11:31:12 AM Eastern Daylight Time	08/01/2014 11:34:28 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Plus Plan (HMO)	01	01		1			H5087	017	0	2015	Los Angeles		2	1089	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	018	0	1	01	01	H5087_018_0	8		1	08/04/2014	2015.02	08/04/2014 08:56:24 PM Eastern Daylight Time	08/05/2014 11:31:25 AM Eastern Daylight Time	08/01/2014 11:34:38 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Plus Plan (HMO)	01	01		1			H5087	018	0	2015	Fresno		2	103	2			2							www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5087	020	0	1	01	01	H5087_020_0	8	2	1	08/04/2014	2015.02	08/04/2014 08:56:46 PM Eastern Daylight Time	08/05/2014 11:31:39 AM Eastern Daylight Time	08/01/2014 11:34:58 AM Eastern Daylight Time			08/06/2014 02:49:16 PM Eastern Daylight Time	EASY CHOICE HEALTH PLAN INC.	Easy Choice Health Plan	www.easychoicehealthplan.com	Easy Choice Access Plan (HMO SNP)	01	01		1			H5087	020	0	2015	Fresno, San Joaquin, Stanislaus		2	244	2			1	3		1	5			www.easychoicehealthplan.com	www.easychoicehealthplan.com	www.easychoicehealthplan.com	(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(866)999-3945		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5106	013	0	1	04	01	H5106_013_0	11		1	08/05/2014	2015.01	08/05/2014 12:26:57 PM Eastern Daylight Time	08/01/2014 09:22:46 AM Eastern Daylight Time	08/01/2014 11:05:09 AM Eastern Daylight Time			08/05/2014 12:36:49 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Health Insurance Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO Standard (PPO)	01	04		1			H5106	013	0	2015	West Virginia Region 1 counties		2		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H5106	027	0	1	04	01	H5106_027_0	13		1	07/17/2014	2015.01	07/17/2014 03:10:18 PM Eastern Daylight Time	08/01/2014 09:23:05 AM Eastern Daylight Time	08/01/2014 11:06:14 AM Eastern Daylight Time			08/05/2014 12:36:49 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Health Insurance Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO ValueRx (PPO)	01	04		1			H5106	027	0	2015	West Virginia Region 1 counties		2		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		2					2					
H5106	806	0	1	04	01	H5106_806_0	7		1	05/29/2014	2015.01	05/29/2014 08:07:39 AM Eastern Daylight Time	07/03/2014 08:36:53 AM Eastern Daylight Time				07/14/2014 03:19:18 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Health Insurance Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MA-PDP WV Non-Calendar (PPO)	01	04		1			H5106	806	0	2015	ALL WV COUNTIES		1		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					
H5106	807	0	1	04	01	H5106_807_0	7		1	05/27/2014	2015.01	05/27/2014 10:51:57 AM Eastern Daylight Time	07/03/2014 08:37:29 AM Eastern Daylight Time				07/14/2014 03:19:18 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Health Insurance Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MA WV (PPO)	01	04		1			H5106	807	0	2015	ALL WV COUNTIES		1		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899										(711)-		(711)-		(800)227-8210		(800)227-8210										1	1	011111111110100111111111001110000110	2		1					
H5106	808	0	1	04	01	H5106_808_0	7		1	05/27/2014	2015.01	05/27/2014 10:52:25 AM Eastern Daylight Time	07/03/2014 08:38:00 AM Eastern Daylight Time				07/14/2014 03:19:18 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	Highmark Health Insurance Company	www.highmarkbcbswv.com/medicare	Freedom Blue PPO MA-PDP WV (PPO)	01	04		1			H5106	808	0	2015	ALL WV COUNTIES		1		2			2							www.highmarkbcbswv.com/medicare	http://client.formularynavigator.com/clients/hm/default.html	http://www.highmarkbcbswv.com/medicare	(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(888)459-4020		(888)459-4020		(866)739-1899		(866)739-1899		(711)-		(711)-		(800)227-8210		(800)227-8210		(711)-		(711)-		(800)227-8210		(800)227-8210		1	1	011111111110100111111111001110000110	2		1					
H5124	001	0	1	20	08	H5124_001_0	2		1	11/06/2014	2015.03	11/06/2014 12:54:55 PM Eastern Standard Time		11/05/2014 09:53:31 AM Eastern Standard Time			11/06/2014 12:56:16 PM Eastern Standard Time	FRANCISCAN ALLIANCE, INC.	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	001	0	2015	Central Indiana		2		2			2								franciscanalliance.org	carekinesis.org									(844)817-7223		(317)782-8012		(800)743-3333		(317)782-8012										(800)743-3333		(317)528-6395		(800)743-3333		(800)743-3333												
H5124	002	0	1	20	08	H5124_002_0	2		1	11/06/2014	2015.03	11/06/2014 12:55:12 PM Eastern Standard Time		11/05/2014 10:02:50 AM Eastern Standard Time			11/06/2014 12:56:16 PM Eastern Standard Time	FRANCISCAN ALLIANCE, INC.	Franciscan  Senior Health & Wellness	FranciscanStFrancis.org	Franciscan Senior Health and Wellness (PACE)	08	20		1			H5124	002	0	2015	Central Indiana		2		2			2								franciscanalliance.org	carekinesis.org									(844)817-7223		(317)782-8012		(800)743-3333		(317)782-8012										(800)743-3333		(317)528-6395		(800)743-3333		(800)743-3333												
H5141	001	0	1	04	01	H5141_001_0	7		1	08/12/2014	2015.02	08/12/2014 03:08:44 PM Central Daylight Time	08/06/2014 01:23:37 PM Central Daylight Time	08/04/2014 01:39:26 PM Central Daylight Time			08/12/2014 03:57:05 PM Central Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.org	CarePoint Advantage (PPO)	01	04		1			H5141	001	0	2015	Hudson County		2		2			2							www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5141	003	0	1	04	01	H5141_003_0	6		1	07/14/2014	2015.02	07/14/2014 10:32:11 AM Central Daylight Time	07/25/2014 08:00:58 AM Central Daylight Time	07/08/2014 08:17:09 PM Central Daylight Time			07/25/2014 08:51:15 AM Central Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.org	CarePoint Guardian (PPO SNP)	01	04		1			H5141	003	0	2015	Hudson County		2		2			1	1	3	1				www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5141	004	0	1	04	01	H5141_004_0	6		1	08/06/2014	2015.02	08/06/2014 02:40:27 PM Central Daylight Time	08/06/2014 01:12:14 PM Central Daylight Time	08/04/2014 01:40:04 PM Central Daylight Time			08/06/2014 02:50:44 PM Central Daylight Time	CAREPOINT INSURANCE COMPANY	CarePoint Health Plans	www.carepointadvantage.com	CarePoint Advantage NJ (PPO)	01	04		1			H5141	004	0	2015	NJ counties- Bergen,Essex,Passaic,Somerset,Union		2		2			2							www.carepointadvantage.org	www.carepointadvantage.org	www.carepointadvantage.org	(888)657-1207		(201)432-2133	100	(855)593-5757		(201)432-2133	100	(855)479-3657		(201)432-2133	100	(855)593-5757		(201)432-2133		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5151	007	0	1	01	01	H5151_007_0	7	2	1	08/05/2014	2015.01	08/05/2014 04:29:55 PM Central Daylight Time	08/11/2014 11:52:43 AM Central Daylight Time	08/06/2014 10:05:35 AM Central Daylight Time			08/11/2014 01:01:39 PM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare SNP (HMO SNP)	01	01		1			H5151	007	0	2015	East Ohio, Northern WV		2	300	2			1	3		1	4			www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					1
H5151	010	0	1	02	01	H5151_010_0	3		1	07/22/2014	2015.01	07/22/2014 11:57:50 AM Central Daylight Time	08/05/2014 04:22:20 PM Central Daylight Time	08/06/2014 10:05:45 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare POS (HMO-POS)	01	02		1			H5151	010	0	2015	Kanawa County WV		2	50	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					2
H5151	011	1	1	01	01	H5151_011_1	5		1	07/22/2014	2015.01	07/22/2014 11:57:59 AM Central Daylight Time	08/05/2014 04:22:42 PM Central Daylight Time	08/06/2014 10:05:57 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option II (HMO)	01	01		1			H5151	011	1	2015	East Ohio, WV	Eastern Ohio, Northern WV	2	6000	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					2
H5151	011	2	1	01	01	H5151_011_2	5		1	07/22/2014	2015.01	07/22/2014 11:58:09 AM Central Daylight Time	08/05/2014 04:23:07 PM Central Daylight Time	08/06/2014 10:06:09 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option II (HMO)	01	01		1			H5151	011	2	2015	East Ohio, WV	Southeastern Ohio, Central and Southern WV	2	1000	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					2
H5151	012	1	1	01	01	H5151_012_1	4		1	07/22/2014	2015.01	07/22/2014 11:58:18 AM Central Daylight Time	07/16/2014 08:28:30 AM Central Daylight Time				07/22/2014 12:09:07 PM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option I (HMO)	01	01		1			H5151	012	1	2015	East Ohio, WV	Eastern Ohio, Northern WV	2	600	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										2					2					2
H5151	012	2	1	01	01	H5151_012_2	4		1	07/22/2014	2015.01	07/22/2014 11:58:27 AM Central Daylight Time	07/16/2014 08:28:59 AM Central Daylight Time				07/22/2014 12:09:07 PM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Option I (HMO)	01	01		1			H5151	012	2	2015	East Ohio, WV	Southeastern OH, Central and Southern WV	2	100	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										2					2					2
H5151	802	0	1	01	01	H5151_802_0	2		1	05/29/2014	2015.01	05/29/2014 08:58:51 AM Central Daylight Time	06/02/2014 03:25:48 PM Central Daylight Time				06/02/2014 05:14:53 PM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Employer (HMO)	01	01		1			H5151	802	0	2015	Southeast Ohio, Northern West Virginia		1	183	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										1	1	011111111111111110111111011111000001	1	011111111111110111111010001	1					1
H5151	803	0	1	01	01	H5151_803_0	2		1	05/29/2014	2015.01	05/29/2014 09:00:34 AM Central Daylight Time	06/02/2014 03:26:11 PM Central Daylight Time				06/02/2014 05:14:53 PM Central Daylight Time	HEALTH PLAN OF THE UPPER OHIO VALLEY	The Health Plan	www.healthplan.org	SecureCare - Employer (HMO)	01	01		1			H5151	803	0	2015	Southeast Ohio, Northern West Virginia		1	1644	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		1	1	011111111111111110111111011111000001	1	011111111111110111111010001	1					1
H5167	001	0	1	20	08	H5167_001_0	1		1	05/20/2014	2015.01	05/20/2014 11:53:37 AM Mountain Daylight Time		05/20/2014 10:12:27 AM Mountain Daylight Time			05/20/2014 11:58:21 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	001	0	2015	Colorado Springs Metro Area		2		2			2								www.rmhcare.org	www.rmhcare.org									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335											
H5167	002	0	1	20	08	H5167_002_0	1		1	05/20/2014	2015.01	05/20/2014 11:54:57 AM Mountain Daylight Time		05/20/2014 10:18:47 AM Mountain Daylight Time			05/20/2014 11:58:21 AM Mountain Daylight Time	ROCKY MOUNTAIN HEALTH CARE SERVICES	Rocky Mountain PACE	rmhcare.org	Rocky Mountain PACE (PACE)	08	20		1			H5167	002	0	2015	Colorado Springs Metro Area		2		2			2								www.rmhcare.org	www.rmhcare.org									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335									(855)207-0702	335	(719)314-2327	335	(855)207-0702	335	(719)314-2327	335											
H5172	002	0	1	48	05	H5172_002_0	2		1	07/02/2014	2015.01	07/02/2014 04:05:13 PM Pacific Daylight Time					07/02/2014 04:24:52 PM Pacific Daylight Time	COMMUNITY HEALTH GROUP	Community Health Group	www.chgsd.com	CommuniCare Advantage Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H5172	002	0	2015	San Diego, California		2		2			2							http://www.chgsd.com/physicianFinderLite.aspx	http://www.chgsd.com/	http://www.chgsd.com/	(888)244-4430		(619)422-0422		(888)244-4430		(619)422-0422		(888)244-4430		(619)422-0422		(888)244-4430		(619)422-0422		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		(855)266-4584		2					2					2
H5190	001	0	1	01	01	H5190_001_0	7	2	1	08/06/2014	2015.01	08/06/2014 01:06:57 PM Pacific Daylight Time	08/06/2014 12:49:35 PM Pacific Daylight Time	08/05/2014 03:44:30 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	001	0	2015	13 Counties in Central and North Florida		2	376	2			1	3		1	4			http://advantage.sunshinehealth.com	http://advantage.sunshinestatehealth.com	http://www.sunshinestatehealth.com/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H5190	002	0	1	01	01	H5190_002_0	9	2	1	08/06/2014	2015.01	08/06/2014 01:06:47 PM Pacific Daylight Time	08/06/2014 12:52:22 PM Pacific Daylight Time	08/05/2014 03:44:47 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	002	0	2015	Counties: Hillsborough, Pasco, Pinellas, St. Lucie		2	251	2			1	3		1	4			http://advantage.sunshinehealth.com	http://advantage.sunshinestatehealth.com	http://www.sunshinestatehealth.com/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H5190	003	0	1	01	01	H5190_003_0	9	2	1	08/05/2014	2015.01	08/05/2014 02:20:45 PM Pacific Daylight Time	08/05/2014 04:00:59 PM Pacific Daylight Time	08/05/2014 03:45:05 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	003	0	2015	Counties: Broward, Palm Beach		2	288	2			1	3		1	4			http://advantage.sunshinehealth.com	http://advantage.sunshinestatehealth.com	http://www.sunshinestatehealth.com/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H5190	004	0	1	01	01	H5190_004_0	8	2	1	08/06/2014	2015.01	08/06/2014 10:49:56 AM Pacific Daylight Time	08/05/2014 04:01:39 PM Pacific Daylight Time	08/05/2014 03:45:18 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	SUNSHINE STATE HEALTH PLAN, INC.	Sunshine Health	http://advantage.sunshinestatehealth.com	Sunshine Health Advantage (HMO SNP)	01	01		1			H5190	004	0	2015	Miami-Dade County		2	138	2			1	3		1	4			http://advantage.sunshinehealth.com	http://advantage.sunshinestatehealth.com	http://www.sunshinestatehealth.com/	(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(877)935-8022		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					2
H5207	001	0	1	01	01	H5207_001_0	6	2	1	08/12/2014	2015.01	08/12/2014 03:17:09 PM Central Daylight Time	08/11/2014 12:20:23 PM Central Daylight Time	08/06/2014 01:28:12 PM Central Daylight Time			08/12/2014 04:18:08 PM Central Daylight Time	COMMUNITY CARE HEALTH PLAN, INC.	Community Care	www.CommunityCareInc.org	Community Care's Partnership Program (HMO SNP)	01	01		1			H5207	001	0	2015	Kenosha, Milwaukee, Racine and Waukesha Counties		2	282	2			1	3		1	5			www.CommunityCareInc.org	www.communitycareinc.org/Assets/Formulary.pdf	www.communitycareinc.org	(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H5209	002	0	1	01	01	H5209_002_0	2	2	1	05/02/2014	2015.01	05/02/2014 11:27:27 AM Central Daylight Time	08/05/2014 04:17:25 PM Central Daylight Time	08/05/2014 04:17:51 PM Central Daylight Time			08/06/2014 08:30:18 AM Central Daylight Time	CARE WISCONSIN HEALTH PLAN, INC.	Care Wisconsin Health Plan, Inc.	www.carewisc.org/partnership	Partnership (HMO SNP)	01	01		1			H5209	002	0	2015	Dane County		2	1020	2			1	3		1	5			www.carewisc.org/partnership	www.carewisc.org/partnership	www.carewisc.org/partnership	(800)963-0035		(608)240-0035		(800)963-0035		(608)245-3075		(800)963-0035		(608)240-0035		(800)963-0035		(608)245-3075		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	2		2		1					1
H5211	001	0	1	02	01	H5211_001_0	6		1	07/22/2014	2015.02	07/22/2014 09:30:55 AM Central Daylight Time	06/02/2014 07:11:36 AM Central Daylight Time				07/22/2014 09:33:53 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/advocare	Advocare Spirit (HMO-POS)	01	02		1			H5211	001	0	2015	Central, Northern, Western and South Central WI		2	6089	2			2							www.securityhealth.org/advocareproviders	www.securityhealth.org/advocareformulary	www.securityhealth.org/advocarepharmacies	(877)998-0998		(715)221-9897		(888)456-2188		(715)221-9345										(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898										2					2					2
H5211	002	0	1	02	01	H5211_002_0	9		1	07/22/2014	2015.02	07/22/2014 08:24:19 AM Central Daylight Time	08/05/2014 09:04:59 AM Central Daylight Time	08/05/2014 09:05:29 AM Central Daylight Time			08/05/2014 10:05:27 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/advocare	Advocare Essence Rx (HMO-POS)	01	02		1			H5211	002	0	2015	Central, Northern, Western and South Central WI		2	17395	2			2							www.securityhealth.org/advocareproviders	www.securityhealth.org/advocareformulary	www.securityhealth.org/advocarepharmacies	(877)998-0998		(715)221-9897		(888)456-2188		(715)221-9345		(877)998-0998		(715)221-9897		(888)456-2188		(715)221-9345		(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898		2					2					2
H5211	003	0	1	02	01	H5211_003_0	6		1	07/22/2014	2015.02	07/22/2014 08:27:28 AM Central Daylight Time	06/02/2014 07:13:06 AM Central Daylight Time				07/22/2014 09:33:53 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/advocare	Advocare Essence (HMO-POS)	01	02		1			H5211	003	0	2015	Central, Northern, Western and South Central WI		2	7889	2			2							www.securityhealth.org/advocareproviders	www.securityhealth.org/advocareformulary	www.securityhealth.org/advocarepharmacies	(877)998-0998		(715)221-9897		(888)456-2188		(715)221-9345										(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898										2					2					2
H5211	004	0	1	02	01	H5211_004_0	9		1	07/22/2014	2015.02	07/22/2014 08:30:14 AM Central Daylight Time	08/05/2014 09:06:16 AM Central Daylight Time	08/05/2014 09:07:08 AM Central Daylight Time			08/05/2014 10:05:27 AM Central Daylight Time	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Security Health Plan of Wisconsin, Inc.	www.securityhealth.org/advocare	Advocare Spirit Rx (HMO-POS)	01	02		1			H5211	004	0	2015	Central, Northern, Western and South Central WI		2	11557	2			2							www.securityhealth.org/advocareproviders	www.securityhealth.org/advocareformulary	www.securityhealth.org/advocarepharmacies	(877)998-0998		(715)221-9897		(888)456-2188		(715)221-9345		(877)998-0998		(715)221-9897		(888)456-2188		(715)221-9345		(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898		(877)727-2232		(715)221-9898		2					2					2
H5212	001	0	1	20	08	H5212_001_0	2		1	05/20/2014	2015.01	05/20/2014 12:14:05 PM Central Daylight Time		05/31/2014 02:59:27 PM Central Daylight Time			06/02/2014 08:02:55 AM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.CommunityCareInc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	001	0	2015	Milwaukee County, Waukesha County		2		2			2								www.CommunityCareInc.org	www.CommunityCareInc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-												
H5212	002	0	1	20	08	H5212_002_0	2		1	05/20/2014	2015.01	05/20/2014 12:14:56 PM Central Daylight Time		05/31/2014 02:59:27 PM Central Daylight Time			06/02/2014 08:02:55 AM Central Daylight Time	COMMUNITY CARE, INC.	Community Care	www.CommunityCareInc.org	Community Care's PACE Program (PACE)	08	20		1			H5212	002	0	2015	Milwaukee County, Waukesha County		2		2			2								www.CommunityCareInc.org	www.CommunityCareInc.org									(866)992-6600		(414)231-4000		(866)992-6600		(414)231-4000										(711)-		(711)-		(711)-		(711)-												
H5213	001	0	1	20	08	H5213_001_0	1		1	05/28/2014	2015.01	05/28/2014 10:33:01 AM Mountain Daylight Time		05/16/2014 05:50:56 PM Mountain Daylight Time			05/28/2014 10:35:59 AM Mountain Daylight Time	TOTAL COMMUNITY CARE, L.L.C.	Total Community Care	www.TotalCommunityCare.org	Total Community Care (PACE)	08	20		1			H5213	001	0	2015	Albuquerque Metro Area		2		2			2								www.TotalCommunityCare.org	www.pharmerica.com									(505)924-2608		(505)924-2608		(877)277-6163		(303)869-4664										(505)924-2608		(505)924-2608		(877)277-6163		(303)869-4664												
H5213	002	0	1	20	08	H5213_002_0	1		1	05/28/2014	2015.01	05/28/2014 10:33:13 AM Mountain Daylight Time		05/16/2014 05:59:37 PM Mountain Daylight Time			05/28/2014 10:35:59 AM Mountain Daylight Time	TOTAL COMMUNITY CARE, L.L.C.	Total Community Care	www.TotalCommunityCare.org	Total Community Care (PACE)	08	20		1			H5213	002	0	2015	Albuquerque Metro Area		2		2			2								www.TotalCommunityCare.org	www.pharmerica.com									(505)924-2608		(505)924-2608		(505)924-2608		(303)869-4664										(505)924-2608		(505)924-2608		(505)924-2608		(505)924-2608												
H5215	001	0	1	04	01	H5215_001_0	6		1	07/18/2014	2015.01	07/18/2014 04:53:15 PM Central Daylight Time	07/22/2014 01:39:28 PM Central Daylight Time				08/07/2014 02:07:49 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus (PPO)	01	04		1			H5215	001	0	2015	East Central Wisconsin		2	3876	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										2					2					
H5215	002	0	1	04	01	H5215_002_0	6		1	07/18/2014	2015.01	07/18/2014 04:53:07 PM Central Daylight Time	08/05/2014 02:36:14 PM Central Daylight Time	07/31/2014 05:03:34 PM Central Daylight Time			08/06/2014 04:20:34 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy (PPO)	01	04		1			H5215	002	0	2015	East Central Wisconsin		2	14100	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					
H5215	005	0	1	04	01	H5215_005_0	7		1	07/21/2014	2015.01	07/21/2014 02:37:30 PM Central Daylight Time	08/08/2014 08:40:13 AM Central Daylight Time	07/31/2014 05:04:10 PM Central Daylight Time			08/08/2014 08:45:53 AM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy (PPO)	01	04		1			H5215	005	0	2015	East Central Wisconsin		2	2385	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					
H5215	006	0	1	04	01	H5215_006_0	6		1	07/18/2014	2015.01	07/18/2014 04:52:53 PM Central Daylight Time	07/22/2014 01:40:42 PM Central Daylight Time				08/07/2014 02:07:49 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier (PPO)	01	04		1			H5215	006	0	2015	East Central Wisconsin		2	931	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										2					2					
H5215	007	0	1	04	01	H5215_007_0	7	2	1	08/06/2014	2015.01	08/06/2014 12:43:38 PM Central Daylight Time	08/06/2014 12:02:44 PM Central Daylight Time	07/31/2014 05:05:00 PM Central Daylight Time			08/06/2014 04:20:34 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	NetworkCares (PPO SNP)	01	04		1			H5215	007	0	2015	East Central Wisconsin		2	2520	2			1	3		1	2			www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					
H5215	008	0	1	04	01	H5215_008_0	6		1	08/06/2014	2015.01	08/06/2014 09:18:25 AM Central Daylight Time	08/05/2014 02:38:22 PM Central Daylight Time	07/31/2014 05:05:22 PM Central Daylight Time			08/06/2014 04:20:34 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumSelect (PPO)	01	04		1			H5215	008	0	2015	East Central Wisconsin		2	35229	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					
H5215	806	0	1	04	01	H5215_806_0	4		1	06/01/2014	2015.01	06/01/2014 01:25:03 PM Central Daylight Time	06/02/2014 08:07:11 PM Central Daylight Time				06/02/2014 08:09:51 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPlus Pharmacy EGP (PPO)	01	04		1			H5215	806	0	2015	East Central WI		1	300	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	011111111010100110111111001111000110	2		2					
H5215	807	0	1	04	01	H5215_807_0	4		1	06/01/2014	2015.01	06/01/2014 01:25:24 PM Central Daylight Time	06/02/2014 08:07:11 PM Central Daylight Time				06/02/2014 08:09:51 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier EGP (PPO)	01	04		1			H5215	807	0	2015	East Central WI		1	300	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280										(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529										1	1	011111111010100111111111001111000110	2		2					
H5215	808	0	1	04	01	H5215_808_0	4		1	06/01/2014	2015.01	06/01/2014 09:46:33 PM Central Daylight Time	06/02/2014 08:07:11 PM Central Daylight Time				06/02/2014 08:09:51 PM Central Daylight Time	NETWORK HEALTH INSURANCE CORPORATION	Network Health Medicare Advantage Plans	www.networkhealthmedicare.com	Network PlatinumPremier Pharmacy EGP (PPO)	01	04		1			H5215	808	0	2015	East Central WI		1	300	2			2							www.networkhealthmedicare.com/search/providers/index.php	www.networkhealthmedicare.com/search/formulary/index.php	www.networkhealthmedicare.com	(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)378-5234		(920)720-1345		(800)983-7587		(920)720-1280		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	1	011111111010100111111111001111000110	2		2					
H5216	001	0	1	04	01	H5216_001_0	3		1	07/10/2014	2015.02	07/10/2014 11:52:49 AM Eastern Daylight Time	08/04/2014 09:13:18 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-001 (PPO)	01	04		1			H5216	001	0	2015	Milwaukee area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5216	003	0	1	04	01	H5216_003_0	3		1	07/10/2014	2015.02	07/10/2014 04:50:51 PM Eastern Daylight Time	08/04/2014 09:20:30 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-003 (PPO)	01	04		1			H5216	003	0	2015	Green Bay Metro Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5216	006	0	1	04	01	H5216_006_0	3		1	07/10/2014	2015.02	07/10/2014 04:50:59 PM Eastern Daylight Time	08/04/2014 09:56:26 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-006 (PPO)	01	04		1			H5216	006	0	2015	Madison area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5216	009	0	1	04	01	H5216_009_0	3		1	07/10/2014	2015.02	07/10/2014 01:08:26 PM Eastern Daylight Time	08/04/2014 09:22:04 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-009 (PPO)	01	04		1			H5216	009	0	2015	Southern Michigan area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5216	010	0	1	04	01	H5216_010_0	3		1	07/10/2014	2015.02	07/10/2014 01:12:46 PM Eastern Daylight Time	08/04/2014 09:57:58 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H5216-010 (PPO)	01	04		1			H5216	010	0	2015	Central Michigan area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5253	004	0	1	01	01	H5253_004_0	3		1	05/21/2014	2015.02	05/21/2014 05:22:27 PM Central Daylight Time	08/04/2014 02:57:06 PM Central Daylight Time	07/31/2014 03:23:19 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	004	0	2015	Milwaukee Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5253	007	0	1	02	01	H5253_007_0	7		1	07/18/2014	2015.02	07/18/2014 09:36:57 AM Central Daylight Time	08/12/2014 09:42:32 AM Central Daylight Time	07/31/2014 03:23:22 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5253	007	0	2015	Select Counties in Wisconsin		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5253	011	0	1	01	01	H5253_011_0	3		1	05/21/2014	2015.02	05/21/2014 05:23:38 PM Central Daylight Time	08/04/2014 02:59:00 PM Central Daylight Time	07/31/2014 03:23:26 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	011	0	2015	Select counties in Wisconsin		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5253	021	0	1	01	01	H5253_021_0	2		1	05/19/2014	2015.02	05/19/2014 05:35:31 PM Central Daylight Time	05/31/2014 12:59:32 PM Central Daylight Time				05/31/2014 03:30:23 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Essential (HMO)	01	01		1			H5253	021	0	2015	Milwaukee Metro area		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					2
H5253	024	0	1	01	01	H5253_024_0	3	2	1	08/04/2014	2015.02	08/04/2014 05:53:58 PM Central Daylight Time	08/04/2014 04:29:00 PM Central Daylight Time	07/31/2014 03:23:29 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete LP (HMO SNP)	01	01		1			H5253	024	0	2015	Select counties in Wisconsin		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5253	030	0	1	01	01	H5253_030_0	3		1	05/24/2014	2015.02	05/24/2014 09:05:46 PM Central Daylight Time	08/04/2014 03:00:05 PM Central Daylight Time	07/31/2014 03:23:33 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5253	030	0	2015	Jefferson and Rock counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5253	801	0	1	01	01	H5253_801_0	2		1	05/22/2014	2015.02	05/22/2014 09:17:09 AM Central Daylight Time	05/31/2014 01:00:25 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	801	0	2015	Milwaukee and Green Bay Area Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H5253	802	0	1	01	01	H5253_802_0	2		1	05/22/2014	2015.02	05/22/2014 09:17:21 AM Central Daylight Time	05/31/2014 01:00:43 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	802	0	2015	Milwaukee and Green Bay Area Counties		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					1
H5253	805	0	1	01	01	H5253_805_0	2		1	05/22/2014	2015.02	05/22/2014 09:17:27 AM Central Daylight Time	05/31/2014 01:01:00 PM Central Daylight Time				05/31/2014 03:12:50 PM Central Daylight Time	UNITEDHEALTHCARE OF WISCONSIN, INC.	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H5253	805	0	2015	Select Counties in WI		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					1
H5256	001	0	1	18	06	H5256_001_0	4		2	08/01/2014	2015.01	08/01/2014 02:35:22 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates SmartPlan (Cost)	06	18		1			H5256	001	0	2015	Grant, Crawford, Iowa, Lafayette Counties		2	2530	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H5256	002	0	1	18	06	H5256_002_0	4		2	08/01/2014	2015.01	08/01/2014 02:35:37 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates Community Plan (Cost)	06	18		1			H5256	002	0	2015	Grant, Crawford, Iowa, Lafayette Counties		2	325	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H5256	004	0	1	18	06	H5256_004_0	4		2	08/01/2014	2015.01	08/01/2014 02:35:55 PM Central Daylight Time					08/03/2014 07:42:54 AM Central Daylight Time	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	Medical Associates Clinic Health Plan of Wisconsin	www.mahealthcare.com	Medical Associates Freedom Plan (Cost)	06	18		1			H5256	004	0	2015	Grant, Crawford, Iowa, Lafayette Counties		2	240	2			2										(866)821-1365		(563)584-4885		(800)747-8900		(563)556-8070										(800)735-2943		(800)735-2943		(800)735-2943		(800)735-2943										2					2					2
H5262	001	0	1	01	01	H5262_001_0	2		1	05/29/2014	2015.01	05/29/2014 08:10:20 AM Central Daylight Time	06/01/2014 03:57:48 PM Central Daylight Time	06/02/2014 09:48:16 AM Central Daylight Time			06/02/2014 09:52:29 AM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H5262	001	0	2015	La Crosse and SW Wisconsin and NE Iowa		2	7046	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2
H5262	003	0	1	01	01	H5262_003_0	2		1	05/29/2014	2015.01	05/29/2014 08:10:53 AM Central Daylight Time	06/01/2014 03:58:25 PM Central Daylight Time	06/02/2014 09:48:16 AM Central Daylight Time			06/02/2014 09:52:29 AM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Value (w/Rx) (HMO)	01	01		1			H5262	003	0	2015	La Crosse and SW Wisconsin and NE Iowa		2	3789	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2
H5262	004	0	1	01	01	H5262_004_0	2		1	05/16/2014	2015.01	05/16/2014 02:21:07 PM Central Daylight Time	06/01/2014 03:58:55 PM Central Daylight Time				06/02/2014 09:52:29 AM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Value (no Rx) (HMO)	01	01		1			H5262	004	0	2015	La Crosse and SW Wisconsin and NE Iowa		2	1310	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2
H5262	005	0	1	01	01	H5262_005_0	2		1	05/15/2014	2015.01	05/15/2014 04:00:53 PM Central Daylight Time	06/01/2014 03:59:15 PM Central Daylight Time				06/02/2014 09:52:29 AM Central Daylight Time	GUNDERSEN HEALTH PLAN	Gundersen Health Plan, Inc.	www.seniorpreferred.org	Gundersen Senior Preferred Elite (no Rx) (HMO)	01	01		1			H5262	005	0	2015	La Crosse and SW Wisconsin and NE Iowa		2	2548	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2
H5264	002	0	1	18	06	H5264_002_0	5		2	07/17/2014	2015.01	07/17/2014 01:33:12 PM Central Daylight Time					07/17/2014 02:38:37 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Enhanced (Cost)	06	18		1			H5264	002	0	2015	DeanCare Gold		2		2			2							www.deancare.com/doctors-locations			(888)422-3326		(608)827-4372		(877)301-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2
H5264	003	0	1	18	06	H5264_003_0	6		2	07/17/2014	2015.01	07/17/2014 01:15:31 PM Central Daylight Time					07/17/2014 02:38:37 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Basic (Cost)	06	18		1			H5264	003	0	2015	DeanCare Gold		2		2			2							www.deancare.com/doctors-locations	www.deancare.com/drugformulary	www.deancare.com/pharmacy	(888)422-3326		(608)827-4372		(877)301-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2
H5264	005	0	1	18	06	H5264_005_0	5		2	07/17/2014	2015.01	07/17/2014 01:15:59 PM Central Daylight Time					07/17/2014 02:14:38 PM Central Daylight Time	DEAN HEALTH PLAN, INC.	Dean Health Plan, Inc.	deancare.com/medicare	DeanCare Gold Shared Value (Cost)	06	18		1			H5264	005	0	2015	DeanCare Gold		2		2			2							www.deancare.com/doctors-locations	www.deancare.com/drugformulary	www.deancare.com/pharmacy	(888)422-3326		(608)827-4372		(877)301-3326		(608)827-4372										(711)-		(711)-		(711)-		(711)-										2					2					2
H5280	001	0	1	48	05	H5280_001_0	5		1	08/18/2014	2015.01	08/18/2014 03:31:01 PM Pacific Daylight Time					08/18/2014 04:07:44 PM Pacific Daylight Time	MOLINA HEALTHCARE OF OHIO, INC.	Molina Healthcare of Ohio	www.molinahealthcare.com/duals	Molina Dual Options  MyCareOhio (Medicare-Medicaid Plan)	05	48		1			H5280	001	0	2015	Southwest, West Central, and Central Ohio		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4623		(855)665-4623		(855)665-4623		(855)665-4623		(855)665-4623		(855)665-4623		(855)665-4623		(855)665-4623		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5294	001	0	1	01	01	H5294_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 09:49:38 AM Pacific Daylight Time	08/05/2014 04:02:28 PM Pacific Daylight Time	08/05/2014 03:46:02 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	SUPERIOR HEALTH PLAN, INC.	Superior HealthPlan	http://advantage.superiorhealthplan.com	Superior HealthPlan Advantage (HMO SNP)	01	01		1			H5294	001	0	2015	Bexar, Collin, Dallas, Nueces, Rockwall Counties		2	3947	2			1	3		1	3		1	http://advantage.superiorhealthplan.com	http://advantage.superiorhealthplan.com	http://advantage.superiorhealthplan.com	(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(877)935-8023		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H5302	003	0	1	02	01	H5302_003_0	9		1	08/02/2014	2015.01	08/02/2014 12:01:21 PM Eastern Daylight Time	08/04/2014 05:20:20 PM Eastern Daylight Time	08/01/2014 10:00:58 AM Eastern Daylight Time			08/05/2014 02:24:13 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF GEORGIA, INC.	Coventry Health Care	Http://ga.chcadvantra.com	Advantra Silver (HMO-POS)	01	02		1			H5302	003	0	2015	Savannah, Columbus, Augusta and Metro Atlanta Area		2	1000	2			2							Http://Providerdirectory.Coventry-Medicare.com	Http://GAformulary.Coventry-Medicare.com	Http://Pharmacylocator.Coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)893-1443		(855)893-1443		(800)690-3412		(800)690-3412		(855)893-1443		(855)893-1443		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5302	809	0	1	02	01	H5302_809_0	1		1	05/31/2014	2015.01	05/31/2014 09:33:25 AM Eastern Daylight Time	05/31/2014 09:24:04 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF GEORGIA, INC.	Coventry Health Care	http://ga.chcadvantra.com	Advantra (HMO-POS)	01	02		1			H5302	809	0	2015	Georgia		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://Pharmacylocator.Coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)893-1443		(855)893-1443										(711)-		(711)-		(711)-		(711)-										1	1	011100011000000000110010001100000100	2		1	1	011100001000000000110010001100000000	2		1
H5302	810	0	1	02	01	H5302_810_0	1		1	04/28/2014	2015.01	04/28/2014 02:57:59 PM Eastern Daylight Time	05/31/2014 09:24:02 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF GEORGIA, INC.	Coventry Health Care	http://ga.chcadvantra.com	Advantra (HMO-POS)	01	02		1			H5302	810	0	2015	Georgia		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://Pharmacylocator.coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)893-1443		(855)893-1443		(800)690-3412		(800)690-3412		(855)893-1443		(855)893-1443		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100001000000000110000001100000100	2		1	1	011100001000000000110000001100000100	2		1
H5322	001	0	1	02	01	H5322_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:37:36 AM Central Daylight Time	08/12/2014 09:43:33 AM Central Daylight Time	07/31/2014 03:23:36 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	001	0	2015	Select Counties in AL, MO, NM, OH, SC and VA		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	002	0	1	01	01	H5322_002_0	3		1	07/18/2014	2015.02	07/18/2014 09:37:46 AM Central Daylight Time	08/04/2014 05:22:21 PM Central Daylight Time	07/31/2014 03:23:40 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5322	002	0	2015	Fremont county		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	003	0	1	01	01	H5322_003_0	5		1	08/04/2014	2015.02	08/04/2014 05:53:00 PM Central Daylight Time	08/12/2014 09:44:41 AM Central Daylight Time	07/31/2014 03:23:44 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO SNP)	01	01		1			H5322	003	0	2015	Select Counties in FL, IN and NJ		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	004	0	1	02	01	H5322_004_0	5		1	07/18/2014	2015.02	07/18/2014 09:38:17 AM Central Daylight Time	08/12/2014 09:45:44 AM Central Daylight Time	07/31/2014 03:23:48 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	004	0	2015	Atlanta and Augusta Metro areas		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	011	0	1	02	01	H5322_011_0	5		1	07/18/2014	2015.02	07/18/2014 09:38:29 AM Central Daylight Time	08/12/2014 09:47:05 AM Central Daylight Time	07/31/2014 03:23:52 PM Central Daylight Time			08/12/2014 02:26:25 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (HMO-POS SNP)	01	02		1			H5322	011	0	2015	Allegheny, Lebanon and Westmoreland counties		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	016	0	1	01	01	H5322_016_0	2		1	05/30/2014	2015.01	05/30/2014 04:41:26 PM Central Daylight Time	08/04/2014 02:56:19 PM Central Daylight Time	07/31/2014 03:23:55 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5322	016	0	2015	Hampden, MA		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	017	0	1	02	01	H5322_017_0	3		1	07/18/2014	2015.02	07/18/2014 10:10:43 AM Central Daylight Time	08/04/2014 02:57:44 PM Central Daylight Time	07/31/2014 03:23:58 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Signature with Drugs (HMO-POS)	01	02		1			H5322	017	0	2015	Loudoun county, VA		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	018	0	1	02	01	H5322_018_0	2		1	07/18/2014	2015.02	07/18/2014 09:39:00 AM Central Daylight Time	05/30/2014 05:02:39 PM Central Daylight Time				07/18/2014 12:49:44 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Signature without Drugs (HMO-POS)	01	02		1			H5322	018	0	2015	Loudoun county, VA		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671										(711)-		(711)-		(711)-		(711)-										2					2					2
H5322	019	0	1	02	01	H5322_019_0	3		1	07/18/2014	2015.02	07/18/2014 09:39:13 AM Central Daylight Time	08/04/2014 04:21:33 PM Central Daylight Time	07/31/2014 03:24:01 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Guardian (HMO-POS SNP)	01	02		1			H5322	019	0	2015	Erickson Campuses - CO, MA, PA, TX, VA		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	020	0	1	02	01	H5322_020_0	3		1	07/18/2014	2015.02	07/18/2014 09:39:32 AM Central Daylight Time	08/04/2014 04:21:49 PM Central Daylight Time	07/31/2014 03:24:05 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Champion (HMO-POS SNP)	01	02		1			H5322	020	0	2015	Loudoun county, VA		2		2			1	4		1		00000000000000000010		www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	021	0	1	02	01	H5322_021_0	2		1	08/04/2014	2015.02	08/04/2014 06:02:42 PM Central Daylight Time	08/04/2014 04:47:13 PM Central Daylight Time	08/04/2014 11:27:03 AM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.EricksonAdvantage.com	Erickson Advantage Freedom (HMO-POS)	01	02		1			H5322	021	0	2015	Loudoun, VA		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	023	0	1	02	01	H5322_023_0	4		1	05/31/2014	2015.01	05/31/2014 12:12:43 PM Central Daylight Time	08/04/2014 05:42:48 PM Central Daylight Time	07/31/2014 03:25:33 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus (HMO-POS)	01	02		1			H5322	023	0	2015	Androscoggin, Knox, Lincoln, and Oxford		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5322	024	0	1	01	01	H5322_024_0	3		1	05/31/2014	2015.01	05/31/2014 12:31:58 PM Central Daylight Time	08/04/2014 03:05:36 PM Central Daylight Time	07/31/2014 03:25:36 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H5322	024	0	2015	Grafton, Hillsborough, and Rockingham Counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5355	001	0	1	48	05	H5355_001_0	3		1	07/01/2014	2015.01	07/01/2014 01:53:04 PM Pacific Daylight Time					07/01/2014 02:46:21 PM Pacific Daylight Time	IEHP HEALTH ACCESS	IEHP DualChoice	www.iehp.org	IEHP DualChoice (Medicare-Medicaid Plan)	05	48		1			H5355	001	0	2015	Riverside and San Bernardino Counties		2	15000	2			2							www.iehp.org	www.iehp.org	www.iehp.org	(877)273-4347		(877)273-4347		(800)741-4347		(800)741-4347		(877)273-4347		(877)273-4347		(800)741-4347		(800)741-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		2					2					2
H5386	001	0	1	01	01	H5386_001_0	9		1	07/14/2014	2015.01	07/14/2014 08:35:41 AM Pacific Daylight Time	05/30/2014 06:04:32 PM Pacific Daylight Time	05/30/2014 10:33:59 AM Pacific Daylight Time			07/14/2014 08:37:14 AM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan Medicare Plan	www.sharphealthplan.com	North County 65 Plus Plan (HMO)	01	01		1			H5386	001	0	2015	North County 65 Plus Plan San Diego County		2	100	2			2							www.sharphealthplan.com	www.sharphealthplan.com	www.sharphealthplan.com	(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5386	801	0	1	01	01	H5386_801_0	3		1	05/27/2014	2015.01	05/27/2014 02:20:08 PM Pacific Daylight Time	05/30/2014 06:09:55 PM Pacific Daylight Time				06/01/2014 07:27:46 AM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan Medicare Plan	www.sharphealthplan.com	Sharp EGWP Calendar Year (HMO)	01	01		1			H5386	801	0	2015	Sharp San Diego EGWP Calendar Year Plan		1	1000	2			2							www.sharphealthplan.com	www.sharphealthplan.com	www.sharphealthplan.com	(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111101111011110	2		1					2
H5386	802	0	1	01	01	H5386_802_0	3		1	05/28/2014	2015.01	05/28/2014 10:42:05 AM Pacific Daylight Time	05/30/2014 06:08:26 PM Pacific Daylight Time				06/01/2014 07:27:46 AM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan Medicare Plan	www.sharphealthplan.com	Sharp EGWP Non-Calendar Year (HMO)	01	01		1			H5386	802	0	2015	Sharp EGWP Non-Calendar Year San Diego		1	1000	2			2							www.sharphealthplan.com	www.sharphealthplan.com	www.sharphealthplan.com	(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111101111011110	2		1					2
H5386	803	0	1	01	01	H5386_803_0	3		1	05/28/2014	2015.01	05/28/2014 10:42:10 AM Pacific Daylight Time	05/30/2014 06:06:55 PM Pacific Daylight Time				06/01/2014 07:27:46 AM Pacific Daylight Time	SHARP HEALTH PLAN	Sharp Health Plan Medicare Plan	www.sharphealthplan.com	Sharp EGWP MA Only Plan (HMO)	01	01		1			H5386	803	0	2015	Sharp EGWP MA Only Plan San Diego		1	1000	2			2							www.sharphealthplan.com	www.sharphealthplan.com	www.sharphealthplan.com	(800)359-2002		(858)499-8300		(800)359-2002		(858)499-8300										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111101111011110	2		1					2
H5403	001	0	1	20	08	H5403_001_0	1		1	05/23/2014	2015.01	05/23/2014 03:46:09 PM Pacific Daylight Time		05/23/2014 02:18:30 PM Pacific Daylight Time			05/23/2014 03:49:39 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onlok.org	On Lok Lifeways (Dual Eligibles) (PACE)	08	20		1			H5403	001	0	2015	San Francisco, Alameda and Santa Clara counties		2		2			2								N/A	www.onlok.org									(888)996-6565		(415)292-8895		(888)886-6565		(415)292-8784										(888)996-6565		(415)292-8898		(888)886-6565		(415)292-8898												
H5403	002	0	1	20	08	H5403_002_0	1		1	05/23/2014	2015.01	05/23/2014 03:46:46 PM Pacific Daylight Time		05/23/2014 02:18:31 PM Pacific Daylight Time			05/23/2014 03:49:39 PM Pacific Daylight Time	ON LOK SENIOR HEALTH SERVICES	On Lok Lifeways	www.onlok.org	On Lok Lifeways (Medicare Only) (PACE)	08	20		1			H5403	002	0	2015	San Francisco, Alameda and Santa Clara counties		2		2			2								N/A	www.onlok.org									(888)996-6565		(415)292-8895		(888)886-6565		(415)292-8784										(888)996-6565		(415)292-8898		(888)886-6565		(415)292-8898												
H5405	001	0	1	20	08	H5405_001_0	1		1	05/20/2014	2015.01	05/20/2014 10:13:41 AM Pacific Daylight Time		05/16/2014 06:02:44 PM Pacific Daylight Time			05/20/2014 10:18:04 AM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders Independence - Part D (PACE)	08	20		1			H5405	001	0	2015	Alameda and Contra Costa Counties		2		2			2								www.cei.elders.org	www.cei.elders.org									(510)433-1150		(510)433-1150		(510)433-1150		(510)433-1150										(510)433-1165		(510)433-1165		(510)433-1165		(510)433-1165												
H5405	002	0	1	20	08	H5405_002_0	1		1	05/20/2014	2015.01	05/20/2014 10:14:32 AM Pacific Daylight Time		05/16/2014 06:12:51 PM Pacific Daylight Time			05/20/2014 10:18:04 AM Pacific Daylight Time	CENTER FOR ELDERS INDEPENDENCE	Center For Elders' Independence	www.cei.elders.org	Center for Elders-Part D/MediCare, only (PACE)	08	20		1			H5405	002	0	2015	Alameda and Contra Costa Counties		2		2			2								www.cei.elders.org	www.cei.elders.org									(510)433-1150		(510)433-1150		(510)433-1150		(510)433-1150										(510)433-1165		(510)433-1165		(510)433-1165		(510)433-1165												
H5406	001	0	1	20	08	H5406_001_0	2		1	05/30/2014	2015.01	05/30/2014 07:37:19 AM Pacific Daylight Time		05/30/2014 05:05:35 AM Pacific Daylight Time			05/30/2014 07:39:14 AM Pacific Daylight Time	SUTTER HEALTH SACRAMENTO SIERRA REGION	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	001	0	2015	Sacramento Counties		2		2			2							N/A	N/A	N/A									(916)424-8412	13415	(916)424-8412	13404	(916)424-8412		(916)424-8412	13422									(916)424-8412		(916)424-8412		(916)424-8412		(916)424-8412												
H5406	002	0	1	20	08	H5406_002_0	2		1	05/30/2014	2015.01	05/30/2014 07:37:32 AM Pacific Daylight Time		05/30/2014 05:11:42 AM Pacific Daylight Time			05/30/2014 07:39:14 AM Pacific Daylight Time	SUTTER HEALTH SACRAMENTO SIERRA REGION	Sutter SeniorCare PACE	www.sutterseniorcare.org	Sutter SeniorCare (PACE)	08	20		1			H5406	002	0	2015	Sacramento Counties		2		2			2							N/A	N/A	N/A									(916)424-8412	13415	(916)424-8412	13404	(916)424-8412		(916)424-8412	13422									(916)424-8412		(916)424-8412		(916)424-8412		(916)424-8412												
H5410	001	0	1	01	01	H5410_001_0	5		1	08/06/2014	2015.02	08/06/2014 09:39:15 AM Central Daylight Time	08/06/2014 09:52:23 AM Central Daylight Time	07/31/2014 03:49:38 PM Central Daylight Time			08/06/2014 12:56:59 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.lmchealthplans.com	Leon Medical Centers Health Plans - Leon Cares (HMO)	01	01		1			H5410	001	0	2015	Miami-Dade county		2	0	2			2								www.lmchealthplans.com	www.mycignahealthspring.com	(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(866)393-5366		(305)559-5366		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5410	004	0	1	01	01	H5410_004_0	2		1	07/16/2014	2015.02	07/16/2014 02:35:28 PM Central Daylight Time	05/26/2014 11:05:04 AM Central Daylight Time				07/17/2014 09:49:34 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (HMO)	01	01		1			H5410	004	0	2015	Northern Florida		2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879										(711)-		(711)-		(711)-		(711)-										2					2					2
H5410	013	0	1	01	01	H5410_013_0	4	2	1	08/01/2014	2015.02	08/01/2014 03:33:49 PM Central Daylight Time	08/04/2014 01:26:42 PM Central Daylight Time	07/31/2014 03:46:30 PM Central Daylight Time			08/05/2014 09:32:50 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H5410	013	0	2015	Northern Florida		2		2			1	3		1	2				www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5410	018	0	1	02	01	H5410_018_0	4		1	07/16/2014	2015.02	07/16/2014 02:35:53 PM Central Daylight Time	08/04/2014 01:27:14 PM Central Daylight Time	07/31/2014 03:46:41 PM Central Daylight Time			08/05/2014 09:32:50 AM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.mycignahealthspring.com	Cigna-HealthSpring Premier (HMO-POS)	01	02		1			H5410	018	0	2015	Northern Florida		2		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(800)668-3813		(800)668-3813		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5410	807	0	1	01	01	H5410_807_0	1		1	04/28/2014	2015.02	04/28/2014 05:04:22 PM Central Daylight Time	05/28/2014 02:38:58 PM Central Daylight Time				05/29/2014 05:33:04 PM Central Daylight Time	HEALTHSPRING OF FLORIDA	HealthSpring of Florida, Inc.	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H5410	807	0	2015	Statewide Florida		1		2			2								www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(888)281-7867		(888)281-7867		(888)767-1879		(888)767-1879		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111111101110100	1	011111011101011111111111100	1					1
H5414	019	0	1	01	01	H5414_019_0	7		1	08/03/2014	2015.01	08/03/2014 03:25:47 PM Eastern Daylight Time	08/04/2014 05:23:56 PM Eastern Daylight Time	08/01/2014 10:01:07 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5414	019	0	2015	South FL, North FL		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5414	023	0	1	01	01	H5414_023_0	4		1	08/03/2014	2015.01	08/03/2014 03:27:32 PM Eastern Daylight Time	08/04/2014 05:24:38 PM Eastern Daylight Time	08/01/2014 10:01:16 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H5414	023	0	2015	Southwest FL		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5414	024	0	1	01	01	H5414_024_0	5		1	08/03/2014	2015.01	08/03/2014 03:26:00 PM Eastern Daylight Time	08/04/2014 05:26:00 PM Eastern Daylight Time	08/01/2014 10:01:27 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5414	024	0	2015	Central FL		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5414	025	0	1	01	01	H5414_025_0	4		1	08/06/2014	2015.01	08/06/2014 08:56:02 AM Eastern Daylight Time	08/04/2014 08:14:12 PM Eastern Daylight Time	08/01/2014 10:01:36 AM Eastern Daylight Time			08/06/2014 09:22:02 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plus Plan (HMO)	01	01		1			H5414	025	0	2015	Florida		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5414	801	0	1	01	01	H5414_801_0	2		1	05/23/2014	2015.01	05/23/2014 02:14:02 PM Eastern Daylight Time	05/29/2014 04:10:14 PM Eastern Daylight Time				06/01/2014 09:48:58 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5414	801	0	2015	Florida		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H5414	803	0	1	01	01	H5414_803_0	2		1	05/23/2014	2015.01	05/23/2014 02:15:31 PM Eastern Daylight Time	05/29/2014 04:11:08 PM Eastern Daylight Time				06/01/2014 09:48:58 AM Eastern Daylight Time	AETNA HEALTH, INC. (FL)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5414	803	0	2015	Florida		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H5415	056	0	1	04	01	H5415_056_0	4		1	07/11/2014	2015.02	07/11/2014 09:27:35 AM Eastern Daylight Time	08/05/2014 07:41:59 AM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:13:06 AM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	HumanaChoice H5415-056 (PPO)	01	04		1			H5415	056	0	2015	Broward, Miami-Dade and Palm Beach counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5415	070	0	1	04	01	H5415_070_0	3		1	07/11/2014	2015.02	07/11/2014 03:44:02 PM Eastern Daylight Time	08/05/2014 07:46:24 AM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	HumanaChoice H5415-070 (PPO)	01	04		1			H5415	070	0	2015	Martin and St. Lucie counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5415	801	0	1	04	01	H5415_801_0	2		1	05/23/2014	2015.02	05/23/2014 03:28:33 PM Eastern Daylight Time	07/14/2014 09:49:37 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5415	801	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5415	803	0	1	04	01	H5415_803_0	2		1	05/27/2014	2015.02	05/27/2014 02:43:12 PM Eastern Daylight Time	07/14/2014 09:54:31 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5415	803	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5415	804	0	1	04	01	H5415_804_0	2		1	05/23/2014	2015.02	05/23/2014 01:59:17 PM Eastern Daylight Time	07/14/2014 09:51:17 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5415	804	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5415	806	0	2	04	01	H5415_806_0	2		1	05/28/2014	2015.02	05/28/2014 03:04:59 PM Eastern Daylight Time	07/14/2014 09:52:21 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5415	806	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5415	807	0	2	04	01	H5415_807_0	2		1	05/28/2014	2015.02	05/28/2014 03:06:10 PM Eastern Daylight Time	07/14/2014 09:52:36 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5415	807	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5415	808	0	2	04	01	H5415_808_0	2		1	05/28/2014	2015.02	05/28/2014 03:07:07 PM Eastern Daylight Time	07/14/2014 09:52:51 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5415	808	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5415	815	0	1	04	01	H5415_815_0	2		1	05/23/2014	2015.02	05/23/2014 03:30:09 PM Eastern Daylight Time	07/14/2014 09:54:00 AM Eastern Daylight Time				07/14/2014 01:01:56 PM Eastern Daylight Time	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Humana Health Insurance Company of Florida, Inc.	www.humana-medicare.com	Humana Medicare Employer - Walmart (PPO)	01	04		1			H5415	815	0	2015	Select Counties in Florida		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5417	001	0	1	04	01	H5417_001_0	5		1	07/18/2014	2015.02	07/18/2014 09:39:59 AM Central Daylight Time	08/04/2014 05:44:46 PM Central Daylight Time	07/31/2014 03:25:40 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare Nursing Home Plan (PPO SNP)	01	04		1			H5417	001	0	2015	Select Counties in Florida		2		2			1	1	1	1				www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(800)393-0993		(800)393-0993		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5420	001	0	1	01	01	H5420_001_0	3		1	05/30/2014	2015.02	05/30/2014 04:27:49 PM Central Daylight Time	08/04/2014 02:51:47 PM Central Daylight Time	07/31/2014 03:25:43 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	Medica HealthCare Plans, Inc.	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	01	01		1			H5420	001	0	2015	Miami-Dade County		2		2			2							www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)517-6923		(800)517-6923		(711)-		(711)-		(800)517-6923		(800)517-6923		(711)-		(711)-		2					2					2
H5420	003	0	1	01	01	H5420_003_0	2		1	05/30/2014	2015.02	05/30/2014 04:28:23 PM Central Daylight Time	08/04/2014 02:52:15 PM Central Daylight Time	07/31/2014 03:25:46 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	Medica HealthCare Plans, Inc.	www.Medicaplans.com	Medica HealthCare Plans MedicareMax (HMO)	01	01		1			H5420	003	0	2015	Broward County		2		2			2							www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)719-4570		(800)719-4570		(800)407-9069		(800)407-9069		(800)719-4570		(800)719-4570		(800)517-6923		(800)517-6923		(711)-		(711)-		(800)517-6923		(800)517-6923		(711)-		(711)-		2					2					2
H5420	006	0	1	02	01	H5420_006_0	3	2	1	05/31/2014	2015.02	05/31/2014 04:37:26 PM Central Daylight Time	08/04/2014 04:56:11 PM Central Daylight Time	07/31/2014 03:25:49 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	MEDICA HEALTHCARE PLANS, INC.	Medica HealthCare Plans, Inc.	www.Medicaplans.com	Medica HealthCare Plans MedicareMax Plus (HMO-POS SNP)	01	02		1			H5420	006	0	2015	Miami-Dade and Broward County		2		2			1	3		1	2			www.Medicaplans.com	www.Medicaplans.com	www.Medicaplans.com	(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)407-9069		(800)407-9069		(800)507-0544		(800)507-0544		(800)517-6923		(800)517-6923		(711)-		(711)-		(800)517-6923		(800)517-6923		(711)-		(711)-		2					2					2
H5422	007	0	1	01	01	H5422_007_0	12	2	1	08/05/2014	2015.01	08/05/2014 09:11:17 AM Eastern Daylight Time	08/06/2014 02:21:43 PM Eastern Daylight Time	08/06/2014 04:05:23 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BCBSHP Dual Advantage (HMO SNP)	01	01		1			H5422	007	0	2015	Select Counties in Georgia		2	378	2			1	3		1	5			www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5422	008	0	1	01	01	H5422_008_0	12		1	07/14/2014	2015.01	07/14/2014 12:15:34 PM Central Daylight Time	08/06/2014 02:52:40 AM Eastern Daylight Time	08/01/2014 05:31:08 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BlueValue Basic (HMO)	01	01		1			H5422	008	0	2015	Select Counties in Georgia		2	983	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5422	803	0	1	01	01	H5422_803_0	8		1	05/31/2014	2015.01	05/31/2014 11:38:02 AM Pacific Daylight Time	07/15/2014 01:22:59 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	803	0	2015	Georgia Select Counties		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H5422	804	0	1	01	01	H5422_804_0	8		1	05/31/2014	2015.01	05/31/2014 11:38:13 AM Pacific Daylight Time	07/15/2014 01:23:04 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	804	0	2015	Georgia - Select Counties		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H5422	805	0	1	01	01	H5422_805_0	8		1	05/31/2014	2015.01	05/31/2014 11:38:23 AM Pacific Daylight Time	07/15/2014 01:23:10 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Blue Cross Blue Shield Healthcare Plan of Georgia	www.bcbsga.com/medicare	BlueValue (HMO)	01	01		1			H5422	805	0	2015	Georgia - Select Counties		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(866)207-8869		(866)207-8869		(866)412-3060		(866)412-3060		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H5424	001	0	1	04	01	H5424_001_0	2		1	05/30/2014	2015.02	05/30/2014 04:09:45 PM Central Daylight Time	08/04/2014 02:57:41 PM Central Daylight Time	07/31/2014 03:26:45 PM Central Daylight Time			08/06/2014 09:41:15 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 1 (PPO)	01	04		1			H5424	001	0	2015	Honolulu County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5424	003	0	1	04	01	H5424_003_0	1		1	05/28/2014	2015.02	05/28/2014 06:50:41 PM Central Daylight Time	05/30/2014 05:55:02 PM Central Daylight Time				05/31/2014 10:01:43 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Essential (PPO)	01	04		1			H5424	003	0	2015	Honolulu County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					
H5424	005	0	1	04	01	H5424_005_0	3	2	1	05/30/2014	2015.02	05/30/2014 11:05:26 AM Central Daylight Time	08/04/2014 04:57:07 PM Central Daylight Time	07/31/2014 03:26:49 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete (PPO SNP)	01	04		1			H5424	005	0	2015	Honolulu County		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5425	001	0	1	01	01	H5425_001_0	8		1	08/06/2014	2015.01	08/06/2014 02:42:11 PM Pacific Daylight Time	08/05/2014 03:29:30 PM Pacific Daylight Time	07/31/2014 01:33:24 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	001	0	2015	Ventura County		2	1000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	004	0	1	01	01	H5425_004_0	7		1	08/06/2014	2015.01	08/06/2014 11:41:05 AM Pacific Daylight Time	08/06/2014 12:35:40 PM Pacific Daylight Time	07/31/2014 01:35:08 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Signature offered by SCAN Health Plan (HMO)	01	01		1			H5425	004	0	2015	San Diego County		2	2000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	005	0	1	01	01	H5425_005_0	7		1	08/05/2014	2015.01	08/05/2014 02:31:14 PM Pacific Daylight Time	08/05/2014 03:47:46 PM Pacific Daylight Time	07/31/2014 01:35:44 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Classic offered by SCAN Health Plan (HMO)	01	01		1			H5425	005	0	2015	San Diego County		2	8000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	006	0	1	01	01	H5425_006_0	7		1	08/05/2014	2015.01	08/05/2014 04:24:43 PM Pacific Daylight Time	08/05/2014 10:51:59 AM Pacific Daylight Time	07/31/2014 01:36:18 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	006	0	2015	Los Angeles County		2	20600	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	007	0	1	01	01	H5425_007_0	7		1	08/05/2014	2015.01	08/05/2014 02:12:21 PM Pacific Daylight Time	08/05/2014 04:17:38 PM Pacific Daylight Time	07/31/2014 01:36:48 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	007	0	2015	Orange County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	008	0	1	01	01	H5425_008_0	7		1	08/04/2014	2015.01	08/04/2014 11:12:50 AM Pacific Daylight Time	08/05/2014 11:03:13 AM Pacific Daylight Time	07/31/2014 01:37:48 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	008	0	2015	Riverside County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	009	0	1	01	01	H5425_009_0	7		1	08/04/2014	2015.01	08/04/2014 11:13:02 AM Pacific Daylight Time	08/05/2014 11:09:15 AM Pacific Daylight Time	07/31/2014 01:38:20 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	009	0	2015	San Bernardino County		2	11000	2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	010	0	1	01	01	H5425_010_0	7	2	1	08/06/2014	2015.01	08/06/2014 10:20:51 AM Pacific Daylight Time	08/05/2014 11:17:29 AM Pacific Daylight Time	07/31/2014 02:09:30 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO SNP)	01	01		1			H5425	010	0	2015	Los Angeles, Riverside and San Bernardino Counties		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	019	0	1	01	01	H5425_019_0	7		1	08/03/2014	2015.01	08/03/2014 02:26:53 PM Pacific Daylight Time	08/05/2014 11:20:16 AM Pacific Daylight Time	07/31/2014 01:38:42 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	019	0	2015	San Francisco County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	020	0	1	01	01	H5425_020_0	7		1	08/05/2014	2015.01	08/05/2014 11:20:28 AM Pacific Daylight Time	08/05/2014 04:32:09 PM Pacific Daylight Time	07/31/2014 01:39:04 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	020	0	2015	Santa Clara County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	028	0	1	01	01	H5425_028_0	7		1	08/03/2014	2015.01	08/03/2014 02:29:22 PM Pacific Daylight Time	08/06/2014 10:56:43 AM Pacific Daylight Time	07/31/2014 01:39:32 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	028	0	2015	Los Angeles and Orange Counties		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	029	0	1	01	01	H5425_029_0	7	2	1	08/06/2014	2015.01	08/06/2014 10:21:01 AM Pacific Daylight Time	08/05/2014 01:12:27 PM Pacific Daylight Time	07/31/2014 01:44:14 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	029	0	2015	Los Angeles County		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	030	0	1	01	01	H5425_030_0	7	2	1	08/06/2014	2015.01	08/06/2014 10:21:10 AM Pacific Daylight Time	08/05/2014 01:21:02 PM Pacific Daylight Time	07/31/2014 01:44:38 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	030	0	2015	Riverside County		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	031	0	1	01	01	H5425_031_0	7	2	1	08/06/2014	2015.01	08/06/2014 10:21:19 AM Pacific Daylight Time	08/05/2014 01:26:28 PM Pacific Daylight Time	07/31/2014 01:45:06 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections at Home (HMO SNP)	01	01		1			H5425	031	0	2015	San Bernardino County		2		2			1	3		1	5			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	033	0	1	01	01	H5425_033_0	7		1	08/03/2014	2015.01	08/03/2014 02:31:15 PM Pacific Daylight Time	08/05/2014 01:33:24 PM Pacific Daylight Time	07/31/2014 01:45:34 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	033	0	2015	Riverside and San Bernardino Counties		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	034	0	1	01	01	H5425_034_0	7		1	08/04/2014	2015.01	08/04/2014 01:42:23 PM Pacific Daylight Time	08/05/2014 01:38:23 PM Pacific Daylight Time	07/31/2014 01:46:00 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	034	0	2015	Los Angeles and Orange Counties		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	037	0	1	01	01	H5425_037_0	6		1	08/06/2014	2015.01	08/06/2014 03:06:43 PM Pacific Daylight Time	08/06/2014 03:31:46 PM Pacific Daylight Time	07/31/2014 01:46:20 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	037	0	2015	Orange County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	040	0	1	01	01	H5425_040_0	6		1	08/05/2014	2015.01	08/05/2014 05:29:12 PM Pacific Daylight Time	08/05/2014 05:15:31 PM Pacific Daylight Time	07/31/2014 01:52:18 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Plus offered by SCAN Health Plan (HMO)	01	01		1			H5425	040	0	2015	San Diego County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	041	0	1	01	01	H5425_041_0	6		1	08/05/2014	2015.01	08/05/2014 05:43:25 PM Pacific Daylight Time	08/05/2014 05:52:11 PM Pacific Daylight Time	07/31/2014 01:52:46 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	041	0	2015	San Francisco County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	045	0	1	01	01	H5425_045_0	6		1	08/06/2014	2015.01	08/06/2014 12:41:52 PM Pacific Daylight Time	08/05/2014 05:34:16 PM Pacific Daylight Time	07/31/2014 01:53:08 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Plus (HMO)	01	01		1			H5425	045	0	2015	Los Angeles, Riverside, San Bernardino Counties		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	046	0	1	01	01	H5425_046_0	7		1	08/03/2014	2015.01	08/03/2014 02:37:23 PM Pacific Daylight Time	08/05/2014 01:43:12 PM Pacific Daylight Time	07/31/2014 01:53:30 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	046	0	2015	Marin County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	047	0	1	01	01	H5425_047_0	8		1	07/14/2014	2015.01	07/14/2014 02:47:25 PM Pacific Daylight Time	08/05/2014 01:52:38 PM Pacific Daylight Time	07/31/2014 01:53:58 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	047	0	2015	Marin County		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	048	0	1	01	01	H5425_048_0	7		1	07/14/2014	2015.01	07/14/2014 02:48:30 PM Pacific Daylight Time	08/05/2014 01:58:31 PM Pacific Daylight Time	07/31/2014 01:54:20 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	048	0	2015	Marin County		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	050	0	1	01	01	H5425_050_0	7		1	08/05/2014	2015.01	08/05/2014 11:25:43 AM Pacific Daylight Time	08/05/2014 05:44:49 PM Pacific Daylight Time	07/31/2014 01:54:40 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	050	0	2015	Santa Clara County		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	051	0	1	01	01	H5425_051_0	7		1	08/03/2014	2015.01	08/03/2014 02:43:47 PM Pacific Daylight Time	08/05/2014 02:02:38 PM Pacific Daylight Time	07/31/2014 01:55:32 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Options (HMO)	01	01		1			H5425	051	0	2015	San Francisco County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	052	0	1	01	01	H5425_052_0	7		1	08/03/2014	2015.01	08/03/2014 02:50:05 PM Pacific Daylight Time	08/05/2014 02:09:47 PM Pacific Daylight Time	07/31/2014 01:55:54 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	052	0	2015	Napa and Sonoma Counties		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	053	0	1	01	01	H5425_053_0	7		1	08/03/2014	2015.01	08/03/2014 02:58:29 PM Pacific Daylight Time	08/06/2014 03:56:50 PM Pacific Daylight Time	07/31/2014 01:56:12 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	053	0	2015	Napa and Sonoma Counties		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	054	0	1	01	01	H5425_054_0	7		1	08/05/2014	2015.01	08/05/2014 09:15:20 AM Pacific Daylight Time	08/06/2014 04:01:40 PM Pacific Daylight Time	07/31/2014 01:56:30 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	054	0	2015	Napa and Sonoma Counties		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	055	0	1	01	01	H5425_055_0	7		1	08/05/2014	2015.01	08/05/2014 03:12:59 PM Pacific Daylight Time	08/05/2014 04:45:39 PM Pacific Daylight Time	07/31/2014 01:57:02 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Scripps Heart First offered by SCAN Health Plan (HMO SNP)	01	01		1			H5425	055	0	2015	San Diego County		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	056	0	1	01	01	H5425_056_0	7		1	08/05/2014	2015.01	08/05/2014 09:27:02 AM Pacific Daylight Time	08/05/2014 02:44:26 PM Pacific Daylight Time	07/31/2014 02:10:32 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H5425	056	0	2015	San Joaquin County		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	057	0	1	01	01	H5425_057_0	6	2	1	08/05/2014	2015.01	08/05/2014 03:00:17 PM Pacific Daylight Time	08/05/2014 04:51:08 PM Pacific Daylight Time	07/31/2014 01:57:50 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Connections (HMO SNP)	01	01		1			H5425	057	0	2015	San Joaquin County		2		2			1	3		1	2			www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(866)722-6725		(866)722-6725		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	059	0	1	01	01	H5425_059_0	7		1	08/05/2014	2015.01	08/05/2014 09:13:36 AM Pacific Daylight Time	08/05/2014 02:58:14 PM Pacific Daylight Time	07/31/2014 01:58:08 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	Heart First (HMO SNP)	01	01		1			H5425	059	0	2015	San Francisco County		2		2			1	4		1		00000000000000010000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	060	0	1	01	01	H5425_060_0	7		1	08/05/2014	2015.01	08/05/2014 09:12:43 AM Pacific Daylight Time	08/05/2014 03:05:59 PM Pacific Daylight Time	07/31/2014 01:58:44 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Balance (HMO SNP)	01	01		1			H5425	060	0	2015	San Francisco County		2		2			1	4		1		00000010000000000000		www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	801	0	1	01	01	H5425_801_0	4		1	07/02/2014	2015.01	07/02/2014 02:40:52 PM Pacific Daylight Time	07/18/2014 03:01:22 PM Pacific Daylight Time				07/18/2014 05:41:43 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Employer Group (HMO)	01	01		1			H5425	801	0	2015	Southern and Northern California Counties		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226										(711)-		(711)-		(711)-		(711)-										2					2					2
H5425	803	0	1	01	01	H5425_803_0	4		1	05/20/2014	2015.01	05/20/2014 03:04:40 PM Pacific Daylight Time	07/18/2014 03:05:27 PM Pacific Daylight Time				07/18/2014 05:41:43 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Employer Group (HMO)	01	01		1			H5425	803	0	2015	Southern and Northern California Counties		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5425	804	0	1	01	01	H5425_804_0	4		1	05/20/2014	2015.01	05/20/2014 03:04:46 PM Pacific Daylight Time	07/18/2014 03:09:52 PM Pacific Daylight Time				07/18/2014 05:41:43 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Employer Group (HMO)	01	01		1			H5425	804	0	2015	Southern and Northern California Counties		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5427	052	0	1	01	01	H5427_052_0	6		1	07/18/2014	2015.01	07/18/2014 01:20:31 PM Eastern Daylight Time	07/14/2014 05:33:14 PM Eastern Daylight Time				07/18/2014 02:45:20 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Savings Plan (HMO)	01	01		1			H5427	052	0	2015	Select Counties in Florida		2	1	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740										(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771										2					2					2
H5427	059	0	1	01	01	H5427_059_0	8		1	08/05/2014	2015.01	08/05/2014 02:54:02 PM Eastern Daylight Time	08/05/2014 11:26:02 AM Eastern Daylight Time	07/31/2014 04:45:28 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	059	0	2015	Select Counties in Florida		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	060	0	1	01	01	H5427_060_0	8		1	08/05/2014	2015.01	08/05/2014 02:54:16 PM Eastern Daylight Time	08/05/2014 11:26:50 AM Eastern Daylight Time	07/31/2014 05:24:22 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medicare Plan Rx (HMO)	01	01		1			H5427	060	0	2015	Select Counties in Florida		2	1	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	070	0	1	01	01	H5427_070_0	8		1	08/05/2014	2015.01	08/05/2014 02:54:35 PM Eastern Daylight Time	08/05/2014 11:27:40 AM Eastern Daylight Time	07/31/2014 05:24:52 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Care (HMO SNP)	01	01		1			H5427	070	0	2015	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	072	0	1	01	01	H5427_072_0	8		1	07/18/2014	2015.01	07/18/2014 01:46:38 PM Eastern Daylight Time	08/05/2014 11:28:26 AM Eastern Daylight Time	07/31/2014 05:25:24 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO SNP)	01	01		1			H5427	072	0	2015	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	077	0	1	01	01	H5427_077_0	8		1	07/18/2014	2015.01	07/18/2014 01:48:21 PM Eastern Daylight Time	08/05/2014 11:29:14 AM Eastern Daylight Time	07/31/2014 05:25:54 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO SNP)	01	01		1			H5427	077	0	2015	Select Counties in Florida		2	0	2			1	4		1		00000000000100000000		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	078	0	1	01	01	H5427_078_0	7	2	1	07/18/2014	2015.01	07/18/2014 01:49:29 PM Eastern Daylight Time	08/05/2014 11:30:06 AM Eastern Daylight Time	07/31/2014 05:26:26 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Partial (HMO SNP)	01	01		1			H5427	078	0	2015	Select Counties in Florida		2	0	2			1	3		1	4			http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	082	0	1	01	01	H5427_082_0	8		1	08/05/2014	2015.01	08/05/2014 02:54:57 PM Eastern Daylight Time	08/05/2014 11:30:58 AM Eastern Daylight Time	07/31/2014 05:26:58 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings (HMO SNP)	01	01		1			H5427	082	0	2015	Select Counties in Florida		2	0	2			1	4		1		00000000000000000010		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	083	0	1	01	01	H5427_083_0	8		1	08/05/2014	2015.01	08/05/2014 02:55:12 PM Eastern Daylight Time	08/05/2014 11:31:54 AM Eastern Daylight Time	07/31/2014 05:27:28 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom VIP Savings COPD (HMO SNP)	01	01		1			H5427	083	0	2015	Select Counties in Florida		2	0	2			1	4		1		00000000000100000000		http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	087	0	1	01	01	H5427_087_0	7	2	1	08/05/2014	2015.01	08/05/2014 02:55:28 PM Eastern Daylight Time	08/05/2014 11:32:48 AM Eastern Daylight Time	07/31/2014 05:28:00 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	www.FreedomHealth.com	Freedom Medi-Medi Full (HMO SNP)	01	01		1			H5427	087	0	2015	Select Counties in Florida		2	0	2			1	3		1	5			http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	088	0	1	01	01	H5427_088_0	8		1	08/05/2014	2015.01	08/05/2014 02:55:42 PM Eastern Daylight Time	08/05/2014 12:12:40 PM Eastern Daylight Time	07/31/2014 05:28:32 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	088	0	2015	select counties in Florida		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	089	0	1	01	01	H5427_089_0	8		1	08/05/2014	2015.01	08/05/2014 02:55:58 PM Eastern Daylight Time	08/05/2014 11:34:20 AM Eastern Daylight Time	07/31/2014 05:29:02 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	089	0	2015	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	091	0	1	01	01	H5427_091_0	8		1	08/05/2014	2015.01	08/05/2014 02:56:40 PM Eastern Daylight Time	08/05/2014 11:35:10 AM Eastern Daylight Time	07/31/2014 05:29:34 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	091	0	2015	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	092	0	1	01	01	H5427_092_0	8		1	08/05/2014	2015.01	08/05/2014 02:57:03 PM Eastern Daylight Time	08/05/2014 11:35:58 AM Eastern Daylight Time	07/31/2014 05:30:04 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	092	0	2015	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	093	0	1	01	01	H5427_093_0	8		1	08/05/2014	2015.01	08/05/2014 02:57:15 PM Eastern Daylight Time	08/05/2014 11:36:48 AM Eastern Daylight Time	07/31/2014 05:30:36 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	093	0	2015	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5427	094	0	1	01	01	H5427_094_0	8		1	08/05/2014	2015.01	08/05/2014 02:57:33 PM Eastern Daylight Time	08/05/2014 11:37:44 AM Eastern Daylight Time	07/31/2014 05:31:08 PM Eastern Daylight Time			08/05/2014 03:14:08 PM Eastern Daylight Time	FREEDOM HEALTH, INC.	Freedom Health, Inc.	http://www.FreedomHealth.com	Freedom Platinum Plan Rx (HMO)	01	01		1			H5427	094	0	2015	Select Counties in FL		2	0	2			2							http://www.FreedomHealth.com	www.freedomhealth.com	www.freedomhealth.com	(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)401-2740		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5428	001	0	1	01	01	H5428_001_0	5	2	1	08/05/2014	2015.01	08/05/2014 02:44:10 PM Pacific Daylight Time	08/06/2014 08:48:31 AM Pacific Daylight Time	08/06/2014 08:49:04 AM Pacific Daylight Time			08/06/2014 09:56:39 AM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	Health Plan of San Mateo	www.hpsm.org	CareAdvantage (HMO SNP)	01	01		1			H5428	001	0	2015	San Mateo County		2	9164	2			1	3		1	5			www.hpsm.org	http://www.hpsm.org/Members.aspx/139.htm	http://www.hpsm.org/Members.aspx/139.htm	(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5430	001	0	1	01	01	H5430_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 03:53:00 PM US Mountain Standard Time	08/05/2014 07:31:57 AM US Mountain Standard Time	08/05/2014 10:07:48 AM US Mountain Standard Time			08/06/2014 09:15:42 AM US Mountain Standard Time	ONECARE BY CARE1ST HEALTH PLAN ARIZONA INC.	Care1st+	www.care1st.com/az/medicare	Care1st+ (HMO SNP)	01	01		1			H5430	001	0	2015	Counties:  Maricopa and Pima		2	710	2			1	3		1	4			http://www.care1st.com/az/healthplans/onecare_medicare_directory.asp	https://www.care1st.com/az/medicare	https://www.care1st.com/az/medicare	(877)778-1855		(602)778-8345		(877)778-1855		(602)778-8345		(877)778-1855		(602)778-8345		(877)778-1855		(602)778-8345		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5431	001	0	1	01	01	H5431_001_0	7		1	08/06/2014	2015.01	08/06/2014 04:33:04 PM Eastern Daylight Time	08/06/2014 05:05:54 PM Eastern Daylight Time	08/05/2014 01:31:18 PM Eastern Daylight Time			08/06/2014 05:30:07 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun SunPlus Advantage Plan (HMO)	01	01		1			H5431	001	0	2015	Miami-Dade		2	2945	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5431	006	0	1	01	01	H5431_006_0	7		1	08/06/2014	2015.01	08/06/2014 05:26:51 PM Eastern Daylight Time	08/06/2014 05:06:55 PM Eastern Daylight Time	08/05/2014 01:31:32 PM Eastern Daylight Time			08/06/2014 05:30:07 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun MediMax (HMO)	01	01		1			H5431	006	0	2015	Broward and Miami-Dade		2	2945	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5431	011	0	1	02	01	H5431_011_0	6		1	08/06/2014	2015.01	08/06/2014 04:33:35 PM Eastern Daylight Time	08/06/2014 05:08:29 PM Eastern Daylight Time	08/05/2014 01:31:53 PM Eastern Daylight Time			08/06/2014 05:30:07 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun SunPlus Advantage POS (HMO-POS)	01	02		1			H5431	011	0	2015	Miami-Dade		2	2000	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5431	012	0	1	01	01	H5431_012_0	6		1	08/06/2014	2015.01	08/06/2014 04:33:53 PM Eastern Daylight Time	08/06/2014 05:10:19 PM Eastern Daylight Time	08/05/2014 01:32:07 PM Eastern Daylight Time			08/06/2014 05:30:07 PM Eastern Daylight Time	HEALTHSUN HEALTH PLANS, INC.	HealthSun Health Plans, Inc.	www.healthsun.com	HealthSun HealthAdvantage Plan (HMO)	01	01		1			H5431	012	0	2015	Broward County		2	279	2			2								www.healthsun.com	www.healthsun.com	(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(877)336-2069		(305)447-4458		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5433	001	0	1	01	01	H5433_001_0	10	2	1	08/05/2014	2015.01	08/05/2014 12:54:51 PM Pacific Daylight Time	08/05/2014 12:46:01 PM Pacific Daylight Time	08/05/2014 12:46:02 PM Pacific Daylight Time			08/05/2014 12:57:14 PM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	OneCare	www.caloptima.org/onecare	OneCare (HMO SNP)	01	01		1			H5433	001	0	2015	Orange County		2	14254	2			1	3		1	5			www.caloptima.org/onecare	http://www.caloptima.org/en/Members/OneCare/MedicarePartD.aspx	http://www.caloptima.org/en/Members/OneCare/YourDoctorHealthNetworkAndPharmacy.aspx	(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(877)412-2734		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H5434	002	0	1	04	01	H5434_002_0	9		1	08/05/2014	2015.01	08/05/2014 03:18:50 PM Eastern Daylight Time	08/06/2014 11:18:45 AM Eastern Daylight Time	07/31/2014 04:15:15 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare PPO (PPO)	01	04		1			H5434	002	0	2015	Select counties in S.FL/ W.FL/C.FL,N.C. FL/N.W FL		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(855)573-5893		(855)573-5893		(855)601-9465		(855)601-9465		(855)573-5893		(855)573-5893		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					
H5434	801	0	1	04	01	H5434_801_0	7		1	06/02/2014	2015.01	06/02/2014 02:26:43 PM Eastern Daylight Time	07/02/2014 01:15:17 PM Eastern Daylight Time				07/11/2014 12:53:06 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group PPO (PPO)	01	04		1			H5434	801	0	2015	State of Florida with National Coverage		1		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	011100010110000011111001001000000000	2		1					
H5434	802	0	1	04	01	H5434_802_0	5		1	06/02/2014	2015.01	06/02/2014 02:27:05 PM Eastern Daylight Time	07/02/2014 01:14:27 PM Eastern Daylight Time				07/11/2014 12:53:06 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group PPO (PPO)	01	04		1			H5434	802	0	2015	State of Florida with National Coverage		1		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		1	1	011100010110000011111001001000000000	2		1					
H5435	001	0	1	09	04	H5435_001_0	1		1	05/30/2014	2015.02	05/30/2014 11:05:34 AM Central Daylight Time	05/30/2014 05:56:08 PM Central Daylight Time				05/31/2014 10:05:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Essential (PFFS)	04	09	2	1			H5435	001	0	2015	Select counties nationwide		2		2			2								www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2										2
H5435	024	0	1	09	04	H5435_024_0	3		1	05/30/2014	2015.02	05/30/2014 04:26:58 PM Central Daylight Time	08/04/2014 03:01:12 PM Central Daylight Time	07/31/2014 03:26:52 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareDirect Rx (PFFS)	04	09	2	1			H5435	024	0	2015	Select counties nationwide		2		2			2								www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757		(866)579-8774		(866)579-8774		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2										2
H5439	001	0	1	04	01	H5439_001_0	2		1	05/27/2014	2015.01	05/27/2014 02:37:55 PM Pacific Daylight Time	08/05/2014 04:22:14 PM Pacific Daylight Time	08/05/2014 04:22:15 PM Pacific Daylight Time			08/05/2014 05:53:53 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet (PPO)	01	04		1			H5439	001	0	2015	San Diego County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5439	005	0	1	04	01	H5439_005_0	2		1	08/04/2014	2015.01	08/04/2014 11:14:09 AM Pacific Daylight Time	08/05/2014 04:22:16 PM Pacific Daylight Time	08/05/2014 04:22:16 PM Pacific Daylight Time			08/05/2014 05:53:53 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet (PPO)	01	04		1			H5439	005	0	2015	San Francisco, CA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5439	007	0	1	04	01	H5439_007_0	2		1	08/04/2014	2015.01	08/04/2014 11:15:29 AM Pacific Daylight Time	08/05/2014 04:22:17 PM Pacific Daylight Time	08/05/2014 04:22:18 PM Pacific Daylight Time			08/05/2014 05:53:53 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet (PPO)	01	04		1			H5439	007	0	2015	Yolo County		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5439	801	0	1	04	01	H5439_801_0	2		1	06/03/2014	2015.01	06/03/2014 12:06:58 PM Pacific Daylight Time	05/31/2014 10:52:32 AM Pacific Daylight Time				06/03/2014 12:09:32 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	801	0	2015	Placer, Sac, S.D., S.F., S. Joaquin, Stan., Yolo		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		1	1	011111111111111111111111111111111111	2		1					
H5439	802	0	1	04	01	H5439_802_0	2		1	06/03/2014	2015.01	06/03/2014 12:07:05 PM Pacific Daylight Time	05/31/2014 10:52:32 AM Pacific Daylight Time				06/03/2014 12:09:32 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	802	0	2015	Placer, Sac, S.D., S.F., S. Joaquin, Stan., Yolo		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										1	1	011111111111111111111111111111111111	2		1					
H5439	803	0	1	04	01	H5439_803_0	2		1	06/03/2014	2015.01	06/03/2014 12:07:10 PM Pacific Daylight Time	05/31/2014 10:52:32 AM Pacific Daylight Time				06/03/2014 12:09:32 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Medicare Advantage Employer (PPO)	01	04		1			H5439	803	0	2015	Placer, Sac, S.D., S.F., S. Joaquin, Stan., Yolo		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)960-4638		(800)960-4638		(800)977-6738		(800)977-6738		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		1	1	011111111111111111111111111111111111	2		1					
H5441	001	0	1	48	05	H5441_001_0	7		1	07/23/2014	2015.01	07/23/2014 10:17:40 AM Eastern Daylight Time					07/23/2014 03:23:29 PM Eastern Daylight Time	MANAGED HEALTH, INC.	Healthfirst Medicare Plan	www.healthfirst.org/medicare	Healthfirst AbsoluteCare FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H5441	001	0	2015	Counties: Ki, Qu, Brx, NY, Rich, Wes, and Na		2	10000	2			2							www.healthfirst.org/medicare	www.healthfirst.org/medicare	www.healthfirst.org/medicare	(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(855)675-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	001	0	1	01	01	H5471_001_0	10	2	1	08/06/2014	2015.01	08/06/2014 11:01:14 AM Eastern Daylight Time	08/05/2014 07:36:14 PM Eastern Daylight Time	08/06/2014 02:44:14 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	001	0	2015	Miami-Dade County		2		2			1	3		1	4			www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	002	0	1	01	01	H5471_002_0	8		1	08/06/2014	2015.01	08/06/2014 11:30:35 AM Eastern Daylight Time	08/05/2014 07:37:24 PM Eastern Daylight Time	08/06/2014 02:45:00 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	002	0	2015	Miami-Dade County		2		2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	004	0	1	01	01	H5471_004_0	8		1	08/06/2014	2015.01	08/06/2014 11:31:24 AM Eastern Daylight Time	08/05/2014 07:38:29 PM Eastern Daylight Time	08/06/2014 02:45:40 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Extra (HMO)	01	01		1			H5471	004	0	2015	Miami-Dade County		2		2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	007	0	1	01	01	H5471_007_0	7	2	1	08/06/2014	2015.01	08/06/2014 11:02:41 AM Eastern Daylight Time	08/05/2014 07:41:08 PM Eastern Daylight Time	08/06/2014 02:46:37 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	007	0	2015	Polk County		2		2			1	3		1	4			www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	008	0	1	01	01	H5471_008_0	9		1	08/06/2014	2015.01	08/06/2014 11:07:42 AM Eastern Daylight Time	08/05/2014 07:42:27 PM Eastern Daylight Time	08/06/2014 02:47:35 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Care (HMO SNP)	01	01		1			H5471	008	0	2015	Miami-Dade County		2		2			1	1	1	1				www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	009	0	1	01	01	H5471_009_0	9		1	08/06/2014	2015.01	08/06/2014 11:49:40 AM Eastern Daylight Time	08/05/2014 07:43:40 PM Eastern Daylight Time	08/06/2014 02:49:20 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Comfort (HMO SNP)	01	01		1			H5471	009	0	2015	Miami-Dade County		2		2			1	1	2	1				www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	012	0	1	01	01	H5471_012_0	9		1	08/06/2014	2015.01	08/06/2014 10:56:41 AM Eastern Daylight Time	08/05/2014 07:44:25 PM Eastern Daylight Time	08/06/2014 02:50:01 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	012	0	2015	Miami-Dade County		2		2			1	4		1		00000010000000000000		www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	020	0	1	01	01	H5471_020_0	8		1	08/06/2014	2015.01	08/06/2014 10:57:58 AM Eastern Daylight Time	08/05/2014 07:47:10 PM Eastern Daylight Time	08/06/2014 02:50:50 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	020	0	2015	Polk County		2		2			1	4		1		00000010000000000000		www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	021	0	1	01	01	H5471_021_0	8		1	08/06/2014	2015.01	08/06/2014 11:42:14 AM Eastern Daylight Time	08/05/2014 07:49:28 PM Eastern Daylight Time	08/06/2014 02:52:03 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	021	0	2015	Polk County		2		2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	022	0	1	01	01	H5471_022_0	8		1	08/06/2014	2015.01	08/06/2014 11:38:55 AM Eastern Daylight Time	08/05/2014 07:50:22 PM Eastern Daylight Time	08/06/2014 02:52:53 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Extra (HMO)	01	01		1			H5471	022	0	2015	Polk County		2		2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	039	0	1	01	01	H5471_039_0	6	2	1	08/06/2014	2015.01	08/06/2014 11:03:57 AM Eastern Daylight Time	08/05/2014 07:51:06 PM Eastern Daylight Time	08/06/2014 02:55:19 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Complete (HMO SNP)	01	01		1			H5471	039	0	2015	Orange Osceola Seminole Counties		2		2			1	3		1	4			www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	042	0	1	01	01	H5471_042_0	8		1	08/06/2014	2015.01	08/06/2014 10:59:09 AM Eastern Daylight Time	08/05/2014 07:52:10 PM Eastern Daylight Time	08/06/2014 02:56:52 PM Eastern Daylight Time			08/07/2014 10:14:10 AM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply Level (HMO SNP)	01	01		1			H5471	042	0	2015	Orange Osceola Seminole Counties		2		2			1	4		1		00000010000000000000		www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5471	043	0	1	01	01	H5471_043_0	6		1	08/06/2014	2015.01	08/06/2014 11:39:45 AM Eastern Daylight Time	08/05/2014 07:53:13 PM Eastern Daylight Time	08/06/2014 02:57:39 PM Eastern Daylight Time			08/06/2014 04:25:33 PM Eastern Daylight Time	SIMPLY HEALTHCARE PLANS, INC.	Simply Healthcare Plans, Inc.	www.mysimplymedicare.com	Simply More (HMO)	01	01		1			H5471	043	0	2015	Orange Osceola Seminole Counties		2		2			2							www.mysimplymedicare.com	http://www.simplyhealthcareplans.com/medicare/prescription-drug-benefit/formularies	http://www.simplyhealthcareplans.com/medicare/pharmacy	(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(877)577-0115		(877)577-0115		(888)577-0212		(888)577-0212		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5475	001	0	1	01	01	H5475_001_0	8	2	1	07/22/2014	2015.01	07/22/2014 08:29:24 PM Central Daylight Time	08/11/2014 02:24:55 PM Central Daylight Time	08/06/2014 04:28:40 PM Central Daylight Time			08/11/2014 02:26:39 PM Central Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Advantage Plan of Michigan (HMO SNP)	01	01		1			H5475	001	0	2015	Southern Michigan and Northern Ohio		2	3500	2			1	3		1	5			www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5475	002	0	1	01	01	H5475_002_0	6		1	08/06/2014	2015.01	08/06/2014 03:13:39 PM Central Daylight Time	08/06/2014 05:28:40 PM Eastern Daylight Time	08/06/2014 05:28:40 PM Eastern Daylight Time			08/06/2014 07:27:16 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Prime (HMO)	01	01		1			H5475	002	0	2015	Southern Michigan and Northern Ohio		2	744	2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5493	001	0	1	20	08	H5493_001_0	1		1	06/02/2014	2015.01	06/02/2014 02:57:28 PM Central Daylight Time		06/01/2014 09:53:20 PM Central Daylight Time			06/02/2014 02:58:35 PM Central Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	St. Francis LIFE	www.stfrancishealthcare.org	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	001	0	2015	LIFE at St. Francis Healthcare, Inc		2		2			2								www.stfrancishealthcare.org	www.stfrancishealthcare.org									(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240										(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240												
H5493	002	0	1	20	08	H5493_002_0	1		1	06/02/2014	2015.01	06/02/2014 02:57:47 PM Central Daylight Time		06/01/2014 09:55:28 PM Central Daylight Time			06/02/2014 02:58:35 PM Central Daylight Time	LIFE AT ST. FRANCIS HEALTHCARE, INC.	St. Francis LIFE	www.stfrancishealthcare.org	LIFE at St. Francis Healthcare, Inc (PACE)	08	20		1			H5493	002	0	2015	LIFE at St. Francis Healthcare, Inc		2		2			2								www.stfrancishealthcare.org	www.stfrancishealthcare.org									(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240										(800)000-0000		(302)575-8240		(800)000-0000		(302)575-8240												
H5507	001	0	1	04	01	H5507_001_0	2		1	07/08/2014	2015.02	07/08/2014 11:51:45 AM Central Daylight Time	08/04/2014 02:31:14 PM Central Daylight Time	07/31/2014 03:26:55 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H5507	001	0	2015	Select counties in Illinois and Missouri		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5508	001	0	1	04	01	H5508_001_0	14		1	07/22/2014	2015.01	07/22/2014 09:50:02 AM Eastern Daylight Time	08/07/2014 07:38:46 AM Eastern Daylight Time	08/07/2014 07:38:46 AM Eastern Daylight Time			08/07/2014 11:18:03 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Enhanced (PPO)	01	04		1			H5508	001	0	2015	Central and Northern Indiana		2	3627	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					
H5508	002	0	1	04	01	H5508_002_0	11		1	07/22/2014	2015.01	07/22/2014 09:51:12 AM Eastern Daylight Time	07/17/2014 12:06:09 PM Eastern Daylight Time				07/22/2014 10:32:21 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Preferred (PPO)	01	04		1			H5508	002	0	2015	Central and Northern Indiana		2	752	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					
H5508	005	0	1	04	01	H5508_005_0	15		1	07/24/2014	2015.01	07/24/2014 01:52:34 PM Eastern Daylight Time	08/07/2014 07:38:46 AM Eastern Daylight Time	08/07/2014 07:38:46 AM Eastern Daylight Time			08/07/2014 11:18:03 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Select (PPO)	01	04		1			H5508	005	0	2015	Central and Northern Indiana		2	10117	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					
H5508	006	0	1	04	01	H5508_006_0	13		1	07/22/2014	2015.01	07/22/2014 09:52:02 AM Eastern Daylight Time	08/07/2014 07:38:47 AM Eastern Daylight Time	08/07/2014 07:38:47 AM Eastern Daylight Time			08/07/2014 11:18:03 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Choice (PPO)	01	04		1			H5508	006	0	2015	Central and Northern Indiana		2	3118	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					
H5508	801	0	1	04	01	H5508_801_0	4		1	05/28/2014	2015.01	05/28/2014 10:30:33 AM Eastern Daylight Time	07/17/2014 12:06:10 PM Eastern Daylight Time				07/17/2014 02:26:08 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Select Plus Group (PPO)	01	04		1			H5508	801	0	2015	Indiana		1	125	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					
H5508	802	0	1	04	01	H5508_802_0	4		1	05/28/2014	2015.01	05/28/2014 10:38:28 AM Eastern Daylight Time	07/17/2014 12:06:23 PM Eastern Daylight Time				07/17/2014 02:26:08 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Preferred Group (PPO)	01	04		1			H5508	802	0	2015	Indiana		1	50	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					
H5508	803	0	1	04	01	H5508_803_0	4		1	05/28/2014	2015.01	05/28/2014 10:40:31 AM Eastern Daylight Time	07/17/2014 12:06:24 PM Eastern Daylight Time				07/17/2014 02:26:08 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Select Group (PPO)	01	04		1			H5508	803	0	2015	Indiana		1	50	2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					
H5508	804	0	1	04	01	H5508_804_0	4		1	05/28/2014	2015.01	05/28/2014 10:49:11 AM Eastern Daylight Time	07/17/2014 12:06:24 PM Eastern Daylight Time				07/17/2014 02:26:08 PM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Preferred Plus Group (PPO)	01	04		1			H5508	804	0	2015	Indiana		1		2			2							www.advantageplan.com/MAPlans	http://www.advantageplan.com/	http://www.advantageplan.com/	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					
H5509	001	0	1	04	01	H5509_001_0	7		1	08/05/2014	2015.01	08/05/2014 09:30:36 PM Central Daylight Time	08/06/2014 07:08:27 AM Central Daylight Time	08/01/2014 09:01:46 AM Central Daylight Time			08/06/2014 07:33:50 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H5509	001	0	2015	Kansas City Metro Area		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	003	0	1	04	01	H5509_003_0	4		1	08/05/2014	2015.01	08/05/2014 09:26:56 PM Central Daylight Time	08/06/2014 07:09:10 AM Central Daylight Time	08/01/2014 09:01:56 AM Central Daylight Time			08/06/2014 07:33:50 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Coventry Medicare Advantage (PPO)	01	04		1			H5509	003	0	2015	Butler, Harvey, and Sedgwick Counties		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	010	0	1	04	01	H5509_010_0	6		1	08/04/2014	2015.01	08/04/2014 11:05:53 AM Central Daylight Time	08/04/2014 04:16:22 PM Central Daylight Time	08/01/2014 09:02:05 AM Central Daylight Time			08/06/2014 03:04:34 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H5509	010	0	2015	Southeast Kansas/Southwest Missouri		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	011	0	1	04	01	H5509_011_0	5		1	08/04/2014	2015.01	08/04/2014 11:11:47 AM Central Daylight Time	08/08/2014 09:26:42 AM Central Daylight Time	08/01/2014 09:02:15 AM Central Daylight Time			08/08/2014 02:50:30 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H5509	011	0	2015	Springfield/Branson Area		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	012	0	1	04	01	H5509_012_0	4		1	08/04/2014	2015.01	08/04/2014 11:16:22 AM Central Daylight Time	08/04/2014 04:17:32 PM Central Daylight Time	08/01/2014 09:02:25 AM Central Daylight Time			08/06/2014 03:04:34 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H5509	012	0	2015	Topeka/Manhattan Area		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	016	0	1	04	01	H5509_016_0	4		1	08/04/2014	2015.01	08/04/2014 11:51:35 AM Central Daylight Time	08/04/2014 04:18:04 PM Central Daylight Time	08/01/2014 09:02:35 AM Central Daylight Time			08/06/2014 03:04:34 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom (PPO)	01	04		1			H5509	016	0	2015	Arkansas		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1447		(855)893-1447		(866)294-9803		(866)294-9803		(855)893-1447		(855)893-1447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	017	0	1	04	01	H5509_017_0	5		1	08/04/2014	2015.01	08/04/2014 11:50:40 AM Central Daylight Time	08/08/2014 09:27:46 AM Central Daylight Time	08/01/2014 09:02:44 AM Central Daylight Time			08/08/2014 02:50:30 PM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Coventry Freedom (PPO)	01	04		1			H5509	017	0	2015	Oklahoma, Canadian and Tulsa County		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	018	0	1	04	01	H5509_018_0	5		1	08/04/2014	2015.01	08/04/2014 11:55:50 AM Central Daylight Time	08/04/2014 04:19:12 PM Central Daylight Time	08/01/2014 09:06:45 AM Central Daylight Time			08/06/2014 03:04:34 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom Plus (PPO)	01	04		1			H5509	018	0	2015	Kansas City Metro		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	019	0	1	04	01	H5509_019_0	7		1	08/04/2014	2015.01	08/04/2014 12:00:21 PM Central Daylight Time	08/04/2014 04:20:12 PM Central Daylight Time	08/01/2014 09:06:53 AM Central Daylight Time			08/06/2014 03:04:34 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Coventry Total Care (PPO)	01	04		1			H5509	019	0	2015	Topeka KS		2		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5509	801	0	1	04	01	H5509_801_0	2		1	04/25/2014	2015.01	05/09/2014 07:19:23 AM Central Daylight Time	06/25/2014 05:05:49 PM Central Daylight Time				07/21/2014 08:08:54 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom Employer Group (PPO)	01	04		1			H5509	801	0	2015	Arkansas, Kansas, and Missouri		1		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111001111000100	2		1					
H5509	802	0	1	04	01	H5509_802_0	3		1	05/09/2014	2015.01	05/09/2014 07:29:14 AM Central Daylight Time	06/25/2014 05:19:22 PM Central Daylight Time				07/21/2014 08:08:54 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom Employer Group (PPO)	01	04		1			H5509	802	0	2015	Arkansas, Kansas, and Missouri		1		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100101110111001111000100	2		1					
H5509	803	0	1	04	01	H5509_803_0	2		1	04/25/2014	2015.01	05/09/2014 07:24:20 AM Central Daylight Time	06/25/2014 05:23:20 PM Central Daylight Time				07/21/2014 08:08:54 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	COVENTRY HEALTH CARE	coventry-medicare.coventryhealthcare.com	Advantra Freedom Employer Group (PPO)	01	04		1			H5509	803	0	2015	Arkansas, Kansas, and Missouri		1		2			2							providerdirectory.coventry-medicare.com	www.FHDFormulary.coventry-medicare.com	providerdirectory.coventry-medicare.com	(800)727-9712		(800)727-9712		(855)893-1446		(855)893-1446		(866)294-9803		(866)294-9803		(855)893-1446		(855)893-1446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111001111000100	2		1					
H5516	001	0	1	04	01	H5516_001_0	2		1	05/30/2014	2015.02	05/30/2014 04:28:52 PM Central Daylight Time	08/04/2014 02:39:13 PM Central Daylight Time	07/31/2014 03:26:59 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H5516	001	0	2015	Select Counties in North Carolina		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5520	001	0	1	04	01	H5520_001_0	1		1	05/27/2014	2015.01	05/27/2014 04:58:09 PM Pacific Daylight Time	05/31/2014 10:52:44 AM Pacific Daylight Time				05/31/2014 11:34:55 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Aqua (PPO)	01	04		1			H5520	001	0	2015	Portland, Salem, MidVly OR and Clark WA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										2					2					
H5520	002	0	1	04	01	H5520_002_0	2		1	07/02/2014	2015.01	07/02/2014 12:20:50 PM Pacific Daylight Time	08/05/2014 09:49:52 AM Pacific Daylight Time	07/31/2014 07:23:40 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 1 (PPO)	01	04		1			H5520	002	0	2015	Portland, Salem, MidVly, OR and Clark WA		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5520	003	0	1	04	01	H5520_003_0	1		1	05/25/2014	2015.01	05/25/2014 05:42:33 PM Pacific Daylight Time	05/31/2014 10:52:44 AM Pacific Daylight Time				05/31/2014 11:34:55 AM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Aqua (PPO)	01	04		1			H5520	003	0	2015	Douglas, Jackson and Josephine Counties, OR		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										2					2					
H5520	004	0	1	04	01	H5520_004_0	2		1	08/04/2014	2015.01	08/04/2014 09:58:47 AM Pacific Daylight Time	08/05/2014 09:47:48 AM Pacific Daylight Time	07/31/2014 07:23:56 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 1 (PPO)	01	04		1			H5520	004	0	2015	Douglas, Jackson and Josephine Counties, OR		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	012	1	1	04	01	H5520_012_1	2		1	08/04/2014	2015.01	08/04/2014 10:00:39 AM Pacific Daylight Time	08/05/2014 09:47:58 AM Pacific Daylight Time	07/31/2014 07:24:34 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	1	2015	Portland, Salem, MidVly OR and Clark WA	OR Counties: CK, LA, ML, WA.  WA Counties: CR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	012	2	1	04	01	H5520_012_2	2		1	08/04/2014	2015.01	08/05/2014 03:21:43 PM Pacific Daylight Time	08/05/2014 09:48:08 AM Pacific Daylight Time	07/31/2014 07:24:50 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	2	2015	Portland, Salem, MidVly OR and Clark WA	Benton, Linn and Yamhill Counties, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	012	3	1	04	01	H5520_012_3	2		1	08/04/2014	2015.01	08/05/2014 03:22:05 PM Pacific Daylight Time	08/05/2014 09:48:18 AM Pacific Daylight Time	07/31/2014 07:25:04 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	012	3	2015	Portland, Salem, MidVly OR and Clark WA	Marion and Polk Counties, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	014	0	1	04	01	H5520_014_0	2		1	08/04/2014	2015.01	08/04/2014 10:03:42 AM Pacific Daylight Time	08/05/2014 09:48:28 AM Pacific Daylight Time	07/31/2014 08:02:38 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 3 (PPO)	01	04		1			H5520	014	0	2015	Douglas and Josephine Counties, OR		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	015	1	1	04	01	H5520_015_1	2		1	08/04/2014	2015.01	08/04/2014 10:05:34 AM Pacific Daylight Time	08/05/2014 09:48:38 AM Pacific Daylight Time	07/31/2014 07:26:06 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	015	1	2015	Douglas, Jackson and Josephine Counties, OR	Jackson County, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	015	2	1	04	01	H5520_015_2	2		1	08/04/2014	2015.01	08/04/2014 10:06:12 AM Pacific Daylight Time	08/05/2014 09:48:48 AM Pacific Daylight Time	07/31/2014 07:26:20 PM Pacific Daylight Time			08/05/2014 05:42:07 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Option 2 (PPO)	01	04		1			H5520	015	2	2015	Douglas, Jackson and Josephine Counties, OR	Douglas and Josephine Counties, OR	2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					
H5520	807	0	1	04	01	H5520_807_0	2		1	06/03/2014	2015.01	06/03/2014 12:07:33 PM Pacific Daylight Time	05/31/2014 10:52:44 AM Pacific Daylight Time				06/03/2014 12:09:32 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Aqua Employer (PPO)	01	04		1			H5520	807	0	2015	Ptld, Salem, MdVly, Doug, Jkson, Josephine, Clark		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192										(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955										1	1	011111111111111111111111111111111111	2		1					
H5520	808	0	1	04	01	H5520_808_0	2		1	06/03/2014	2015.01	06/03/2014 12:07:38 PM Pacific Daylight Time	05/31/2014 10:52:44 AM Pacific Daylight Time				06/03/2014 12:09:32 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Employer (PPO)	01	04		1			H5520	808	0	2015	Ptld, Salem, MdVly, Doug, Jkson, Josephine, Clark		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		1	1	011111111111111111111111111111111111	2		1					
H5520	809	0	1	04	01	H5520_809_0	2		1	06/03/2014	2015.01	06/03/2014 12:07:44 PM Pacific Daylight Time	05/31/2014 10:52:44 AM Pacific Daylight Time				06/03/2014 12:09:32 PM Pacific Daylight Time	HEALTH NET LIFE INSURANCE COMPANY	Health Net Life Insurance Company	www.healthnet.com/medicare	Health Net Violet Employer (PPO)	01	04		1			H5520	809	0	2015	Ptld, Salem, MdVly, Doug, Jkson, Josephine, Clark		1		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		1	1	011111111111111111111111111111111111	2		1					
H5521	012	0	1	04	01	H5521_012_0	5		1	08/02/2014	2015.01	08/02/2014 01:55:32 PM Eastern Daylight Time	08/08/2014 11:33:50 AM Eastern Daylight Time	08/01/2014 10:07:03 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	012	0	2015	Central and NE PA		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	013	0	1	04	01	H5521_013_0	5		1	08/02/2014	2015.01	08/02/2014 01:55:43 PM Eastern Daylight Time	08/08/2014 11:26:56 AM Eastern Daylight Time	08/01/2014 10:07:13 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	013	0	2015	Connecticut		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	015	0	1	04	01	H5521_015_0	10		1	09/16/2014	2015.01	09/16/2014 09:42:36 AM Eastern Daylight Time	08/05/2014 02:50:32 PM Eastern Daylight Time	08/01/2014 10:07:23 AM Eastern Daylight Time			09/16/2014 09:44:57 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	015	0	2015	District of Columbia		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	016	0	1	04	01	H5521_016_0	4		1	08/03/2014	2015.01	08/03/2014 05:05:45 PM Eastern Daylight Time	08/05/2014 11:52:04 AM Eastern Daylight Time	08/01/2014 10:07:34 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	016	0	2015	Cook County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	020	0	1	04	01	H5521_020_0	5		1	08/03/2014	2015.01	08/03/2014 04:49:43 PM Eastern Daylight Time	08/04/2014 07:56:30 PM Eastern Daylight Time	08/01/2014 10:07:44 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	020	0	2015	Ohio and Northern Kentucky		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	022	0	1	04	01	H5521_022_0	7		1	08/06/2014	2015.01	08/06/2014 04:27:41 PM Eastern Daylight Time	08/07/2014 06:20:18 PM Eastern Daylight Time	08/01/2014 10:07:53 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	022	0	2015	Clark County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	027	0	1	04	01	H5521_027_0	4		1	07/02/2014	2015.01	07/02/2014 10:21:42 AM Eastern Daylight Time	08/05/2014 11:10:10 AM Eastern Daylight Time	08/01/2014 10:08:03 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Innovation Choice Plan (PPO)	01	04		1			H5521	027	0	2015	Fairfax County and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	028	0	1	04	01	H5521_028_0	11		1	08/05/2014	2015.01	08/05/2014 04:44:55 PM Eastern Daylight Time	08/05/2014 10:04:17 AM Eastern Daylight Time	08/01/2014 10:08:13 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (PPO)	01	04		1			H5521	028	0	2015	Denver and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	033	0	1	04	01	H5521_033_0	5		1	08/02/2014	2015.01	08/02/2014 02:02:06 PM Eastern Daylight Time	08/04/2014 05:27:38 PM Eastern Daylight Time	08/01/2014 10:08:22 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	033	0	2015	South FL, Southwest FL, Central FL, North FL		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	037	0	1	04	01	H5521_037_0	7		1	06/01/2014	2015.01	06/01/2014 02:55:19 AM Eastern Daylight Time	08/11/2014 02:08:00 PM Eastern Daylight Time	08/01/2014 10:08:32 AM Eastern Daylight Time			08/11/2014 02:29:09 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	037	0	2015	Northern NJ		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	040	0	1	04	01	H5521_040_0	7		1	07/21/2014	2015.01	07/21/2014 07:28:43 PM Eastern Daylight Time	08/08/2014 10:47:42 AM Eastern Daylight Time	08/01/2014 10:08:41 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (PPO)	01	04		1			H5521	040	0	2015	New York		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	052	0	1	04	01	H5521_052_0	6		1	06/30/2014	2015.01	06/30/2014 08:26:02 AM Eastern Daylight Time	08/05/2014 09:51:32 AM Eastern Daylight Time	08/01/2014 10:08:51 AM Eastern Daylight Time			08/06/2014 01:24:43 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plus Plan (PPO)	01	04		1			H5521	052	0	2015	National		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	053	0	1	04	01	H5521_053_0	4		1	06/01/2014	2015.01	06/01/2014 01:03:49 AM Eastern Daylight Time	08/05/2014 09:57:54 AM Eastern Daylight Time	08/01/2014 10:09:01 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	053	0	2015	San Diego		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	055	0	1	04	01	H5521_055_0	4		1	08/02/2014	2015.01	08/02/2014 09:30:15 PM Eastern Daylight Time	08/05/2014 06:04:32 PM Eastern Daylight Time	08/01/2014 10:09:11 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	055	0	2015	Clark County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	056	0	1	04	01	H5521_056_0	4		1	06/01/2014	2015.01	06/01/2014 01:10:26 AM Eastern Daylight Time	08/05/2014 10:01:54 AM Eastern Daylight Time	08/01/2014 10:09:21 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	056	0	2015	Orange County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	057	0	1	04	01	H5521_057_0	8		1	08/05/2014	2015.01	08/05/2014 04:42:14 PM Eastern Daylight Time	08/05/2014 10:06:13 AM Eastern Daylight Time	08/01/2014 10:09:33 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (PPO)	01	04		1			H5521	057	0	2015	Denver and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	058	0	1	04	01	H5521_058_0	4		1	08/02/2014	2015.01	08/02/2014 09:36:15 PM Eastern Daylight Time	08/05/2014 06:02:18 PM Eastern Daylight Time	08/01/2014 10:09:43 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	058	0	2015	Bexar and Comal Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	059	0	1	04	01	H5521_059_0	5		1	08/02/2014	2015.01	08/02/2014 09:37:08 PM Eastern Daylight Time	08/05/2014 06:02:26 PM Eastern Daylight Time	08/01/2014 10:09:53 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	059	0	2015	Collin, Dallas and Denton Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	060	0	1	04	01	H5521_060_0	4		1	08/05/2014	2015.01	08/05/2014 01:04:58 PM Eastern Daylight Time	08/05/2014 06:02:26 PM Eastern Daylight Time	08/01/2014 10:10:03 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Choice Plan (PPO)	01	04		1			H5521	060	0	2015	Harris and Montgomery Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	076	0	1	04	01	H5521_076_0	4		1	08/03/2014	2015.01	08/03/2014 01:51:24 PM Eastern Daylight Time	08/04/2014 10:05:36 PM Eastern Daylight Time	08/01/2014 10:10:14 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	076	0	2015	Rochester Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	077	0	1	04	01	H5521_077_0	5		1	08/03/2014	2015.01	08/03/2014 01:54:49 PM Eastern Daylight Time	08/04/2014 10:06:32 PM Eastern Daylight Time	08/01/2014 10:13:59 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	077	0	2015	Broome, Cayuga, Oswego and Tioga counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	081	0	1	04	01	H5521_081_0	3		1	08/03/2014	2015.01	08/03/2014 09:31:00 AM Eastern Daylight Time	08/04/2014 05:24:48 PM Eastern Daylight Time	08/01/2014 10:14:08 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	081	0	2015	North Carolina		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	082	0	1	04	01	H5521_082_0	3		1	08/03/2014	2015.01	08/03/2014 09:29:49 AM Eastern Daylight Time	08/05/2014 10:07:08 AM Eastern Daylight Time	08/01/2014 10:14:19 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	082	0	2015	Richmond and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	083	0	1	04	01	H5521_083_0	3		1	06/01/2014	2015.01	06/01/2014 07:35:25 PM Eastern Daylight Time	08/05/2014 10:08:36 AM Eastern Daylight Time	08/01/2014 10:14:29 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	083	0	2015	Danville City and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	084	0	1	04	01	H5521_084_0	3		1	06/01/2014	2015.01	06/01/2014 07:35:56 PM Eastern Daylight Time	08/05/2014 10:09:52 AM Eastern Daylight Time	08/01/2014 10:14:39 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	084	0	2015	Newport News and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	085	0	1	04	01	H5521_085_0	5		1	08/03/2014	2015.01	08/03/2014 04:55:32 PM Eastern Daylight Time	08/04/2014 08:00:40 PM Eastern Daylight Time	08/01/2014 10:14:49 AM Eastern Daylight Time			08/06/2014 09:43:54 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	085	0	2015	Boone, Campbell and Kenton counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	086	0	1	04	01	H5521_086_0	3		1	08/03/2014	2015.01	08/03/2014 05:07:02 PM Eastern Daylight Time	08/05/2014 11:53:14 AM Eastern Daylight Time	08/01/2014 10:14:58 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	086	0	2015	Cook county		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	087	0	1	04	01	H5521_087_0	4		1	08/03/2014	2015.01	08/03/2014 04:57:12 PM Eastern Daylight Time	08/04/2014 08:02:02 PM Eastern Daylight Time	08/01/2014 10:15:08 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	087	0	2015	Cincinnati and Surrounding area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	088	0	1	04	01	H5521_088_0	4		1	08/03/2014	2015.01	08/03/2014 04:58:31 PM Eastern Daylight Time	08/04/2014 08:03:52 PM Eastern Daylight Time	08/01/2014 10:15:18 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	088	0	2015	Toledo and Surrounding area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	089	0	1	04	01	H5521_089_0	4		1	08/03/2014	2015.01	08/03/2014 04:59:38 PM Eastern Daylight Time	08/04/2014 08:07:32 PM Eastern Daylight Time	08/01/2014 10:15:29 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	089	0	2015	Columbus and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	090	0	1	04	01	H5521_090_0	4		1	08/03/2014	2015.01	08/03/2014 05:02:03 PM Eastern Daylight Time	08/04/2014 08:08:16 PM Eastern Daylight Time	08/01/2014 10:15:39 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	090	0	2015	Clark and Miami counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	091	0	1	04	01	H5521_091_0	4		1	08/03/2014	2015.01	08/03/2014 11:01:40 AM Eastern Daylight Time	08/04/2014 05:20:42 PM Eastern Daylight Time	08/01/2014 10:15:49 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Essential Plan (PPO)	01	04		1			H5521	091	0	2015	Georgia and Alabama counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	092	0	1	04	01	H5521_092_0	5		1	07/15/2014	2015.01	07/15/2014 01:12:29 PM Eastern Daylight Time	08/05/2014 06:02:22 PM Eastern Daylight Time	08/01/2014 10:15:59 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	092	0	2015	Bexar and Comal counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	093	0	1	04	01	H5521_093_0	6		1	08/05/2014	2015.01	08/05/2014 04:41:58 PM Eastern Daylight Time	08/07/2014 06:26:36 PM Eastern Daylight Time	08/01/2014 10:16:09 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	093	0	2015	Collin, Dallas and Denton counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	094	0	1	04	01	H5521_094_0	7		1	08/06/2014	2015.01	08/06/2014 10:22:34 PM Eastern Daylight Time	08/07/2014 06:28:20 PM Eastern Daylight Time	08/01/2014 10:16:19 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (PPO)	01	04		1			H5521	094	0	2015	Harris and Montgomery counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	095	0	1	04	01	H5521_095_0	5		1	06/30/2014	2015.01	06/30/2014 08:23:59 AM Eastern Daylight Time	08/08/2014 11:36:30 AM Eastern Daylight Time	08/01/2014 10:16:28 AM Eastern Daylight Time			08/09/2014 02:14:59 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (PPO)	01	04		1			H5521	095	0	2015	New Castle county		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	098	0	1	04	01	H5521_098_0	5		1	08/04/2014	2015.01	08/04/2014 10:37:44 AM Eastern Daylight Time	08/04/2014 10:09:26 PM Eastern Daylight Time	08/01/2014 10:16:39 AM Eastern Daylight Time			08/05/2014 04:54:30 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Syracuse Prime Plan (PPO)	01	04		1			H5521	098	0	2015	Onondaga county		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5521	801	0	1	04	01	H5521_801_0	4		1	05/19/2014	2015.01	05/19/2014 12:49:08 PM Eastern Daylight Time	07/21/2014 09:12:53 AM Eastern Daylight Time				07/21/2014 10:21:55 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (PPO)	01	04		1			H5521	801	0	2015	National		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					
H5521	802	0	1	04	01	H5521_802_0	2		1	05/19/2014	2015.01	05/19/2014 12:59:56 PM Eastern Daylight Time	05/30/2014 09:49:28 PM Eastern Daylight Time				05/31/2014 12:09:43 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (PPO)	01	04		1			H5521	802	0	2015	National		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					
H5521	805	0	2	04	01	H5521_805_0	1		1	05/19/2014	2015.01	05/19/2014 03:18:01 PM Eastern Daylight Time	05/30/2014 09:51:38 PM Eastern Daylight Time				05/31/2014 12:09:43 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only Plan (PPO)	01	04		2	1		H5521	805	0	2015	National		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					
H5521	806	0	2	04	01	H5521_806_0	1		1	05/19/2014	2015.01	05/19/2014 03:25:25 PM Eastern Daylight Time	05/29/2014 07:22:35 PM Eastern Daylight Time				05/31/2014 12:09:43 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Part B Only Plan w/Rx CY (PPO)	01	04		2	1		H5521	806	0	2015	National		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					
H5521	808	0	1	04	01	H5521_808_0	1		1	05/29/2014	2015.01	05/29/2014 09:36:07 AM Eastern Daylight Time	05/31/2014 04:19:59 PM Eastern Daylight Time				05/31/2014 04:53:33 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare PPO Plan with NCY Rx (PPO)	01	04		1			H5521	808	0	2015	National		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					
H5522	001	0	1	04	01	H5522_001_0	7		1	08/04/2014	2015.01	08/04/2014 11:41:12 AM Eastern Daylight Time	08/05/2014 11:39:10 AM Eastern Daylight Time	08/01/2014 10:16:49 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	001	0	2015	Allegheny County		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)291-5221		(866)291-5221		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	002	0	1	04	01	H5522_002_0	4		1	08/04/2014	2015.01	08/04/2014 11:41:43 AM Eastern Daylight Time	08/05/2014 11:40:56 AM Eastern Daylight Time	08/01/2014 10:16:59 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	002	0	2015	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)291-5221		(866)291-5221		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	004	0	1	04	01	H5522_004_0	3		1	08/04/2014	2015.01	08/04/2014 11:54:06 AM Eastern Daylight Time	08/05/2014 11:45:12 AM Eastern Daylight Time	08/01/2014 10:17:09 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (PPO)	01	04		1			H5522	004	0	2015	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)291-5221		(866)291-5221		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	005	0	1	04	01	H5522_005_0	4		1	08/04/2014	2015.01	08/04/2014 11:56:16 AM Eastern Daylight Time	08/05/2014 11:46:32 AM Eastern Daylight Time	08/01/2014 10:17:18 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver (PPO)	01	04		1			H5522	005	0	2015	Western Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)291-5221		(866)291-5221		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	013	0	1	04	01	H5522_013_0	3		1	08/04/2014	2015.01	08/04/2014 11:58:32 AM Eastern Daylight Time	08/05/2014 11:48:04 AM Eastern Daylight Time	08/01/2014 10:17:29 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Silver Plus (PPO)	01	04		1			H5522	013	0	2015	Central Pennsylvania		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)291-5221		(866)291-5221		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	014	0	1	04	01	H5522_014_0	4		1	08/04/2014	2015.01	08/04/2014 11:43:25 AM Eastern Daylight Time	08/05/2014 11:50:36 AM Eastern Daylight Time	08/01/2014 10:20:37 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	014	0	2015	Philadelphia and Delaware Counties		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)291-5221		(866)291-5221		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	015	0	1	04	01	H5522_015_0	4		1	08/04/2014	2015.01	08/04/2014 12:02:07 PM Eastern Daylight Time	08/05/2014 12:19:48 PM Eastern Daylight Time	08/01/2014 10:20:46 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	015	0	2015	Bucks, Chester and Montgomery		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)291-5221		(866)291-5221		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	017	0	1	04	01	H5522_017_0	2		1	08/04/2014	2015.01	08/04/2014 12:03:50 PM Eastern Daylight Time	08/05/2014 12:21:32 PM Eastern Daylight Time	08/01/2014 10:20:56 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	AdvantraOne (PPO)	01	04		1			H5522	017	0	2015	Central and Western PA		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(866)290-6660		(866)290-6660		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	018	0	1	04	01	H5522_018_0	3		1	08/04/2014	2015.01	08/04/2014 12:05:31 PM Eastern Daylight Time	08/05/2014 12:27:12 PM Eastern Daylight Time	08/01/2014 10:21:07 AM Eastern Daylight Time			08/05/2014 12:35:38 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	ADVANTRA SILVER (PPO)	01	04		1			H5522	018	0	2015	Allegheny		2		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-1440		(855)893-1440		(866)290-6660		(866)290-6660		(855)893-1440		(855)893-1440		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5522	802	0	1	04	01	H5522_802_0	4		1	05/31/2014	2015.01	05/31/2014 06:49:04 AM Eastern Daylight Time	05/31/2014 06:42:50 AM Eastern Daylight Time				06/01/2014 09:00:37 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra MA Only (PPO)	01	04		1			H5522	802	0	2015	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111111111111111011100	2		1					
H5522	803	0	1	04	01	H5522_803_0	3		1	05/29/2014	2015.01	05/29/2014 04:15:08 PM Eastern Daylight Time	05/31/2014 06:42:06 AM Eastern Daylight Time				05/31/2014 03:50:44 PM Eastern Daylight Time	HEALTHASSURANCE PENNSYLVANIA, INC.	HealthAmerica	http://www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H5522	803	0	2015	Pennsylvania		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272		(866)291-5221		(866)291-5221		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111111111011100	2		1					
H5525	004	0	1	04	01	H5525_004_0	3		1	07/10/2014	2015.02	07/10/2014 02:04:09 PM Eastern Daylight Time	08/04/2014 10:30:07 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:13:55 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-004 (PPO)	01	04		1			H5525	004	0	2015	Peoria Illinois area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	005	0	1	04	01	H5525_005_0	3		1	07/10/2014	2015.02	07/10/2014 02:52:24 PM Eastern Daylight Time	08/03/2014 06:09:42 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-005 (PPO)	01	04		1			H5525	005	0	2015	Bucks, Chester, Delaware and Philadelphia counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	006	0	1	04	01	H5525_006_0	3		1	07/10/2014	2015.02	07/10/2014 02:51:20 PM Eastern Daylight Time	08/03/2014 06:04:32 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-006 (PPO)	01	04		1			H5525	006	0	2015	South Central Pennsylvania area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	007	0	1	04	01	H5525_007_0	3		1	07/10/2014	2015.02	07/10/2014 02:50:23 PM Eastern Daylight Time	08/03/2014 06:03:23 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-007 (PPO)	01	04		1			H5525	007	0	2015	North Central Pennsylvania area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	008	0	1	04	01	H5525_008_0	3		1	07/10/2014	2015.02	07/10/2014 01:16:11 PM Eastern Daylight Time	08/05/2014 09:54:45 AM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-008 (PPO)	01	04		1			H5525	008	0	2015	Select Counties in Indiana		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	009	0	1	04	01	H5525_009_0	3		1	07/10/2014	2015.02	07/10/2014 01:17:47 PM Eastern Daylight Time	08/05/2014 09:54:24 AM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-009 (PPO)	01	04		1			H5525	009	0	2015	Lake, Newton, and Porter counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	015	0	1	04	01	H5525_015_0	3		1	07/10/2014	2015.02	07/10/2014 01:30:42 PM Eastern Daylight Time	08/02/2014 12:50:22 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-015 (PPO)	01	04		1			H5525	015	0	2015	Select Louisiana Parishes		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	017	0	1	04	01	H5525_017_0	3		1	07/10/2014	2015.02	07/10/2014 02:47:54 PM Eastern Daylight Time	08/03/2014 06:14:04 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-017 (PPO)	01	04		1			H5525	017	0	2015	Beaver, Butler and Westmoreland counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	018	0	1	04	01	H5525_018_0	7		1	07/21/2014	2015.02	07/21/2014 12:26:18 PM Eastern Daylight Time	08/04/2014 11:57:36 AM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-018 (PPO)	01	04		1			H5525	018	0	2015	Select Counties in New Jersey		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	019	0	1	04	01	H5525_019_0	7		1	07/10/2014	2015.02	07/10/2014 02:19:52 PM Eastern Daylight Time	08/04/2014 11:58:28 AM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-019 (PPO)	01	04		1			H5525	019	0	2015	Select Counties in Maine		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	020	0	1	04	01	H5525_020_0	3		1	07/11/2014	2015.02	07/11/2014 09:20:31 AM Eastern Daylight Time	08/02/2014 01:20:03 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-020 (PPO)	01	04		1			H5525	020	0	2015	Mobile Metro Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	021	0	1	04	01	H5525_021_0	5		1	07/10/2014	2015.02	07/10/2014 01:19:02 PM Eastern Daylight Time	08/02/2014 08:09:12 PM Eastern Daylight Time	08/04/2014 05:04:14 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-021 (PPO)	01	04		1			H5525	021	0	2015	Select counties in Eastern Kentucky		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	022	0	1	04	01	H5525_022_0	5		1	07/10/2014	2015.02	07/10/2014 01:25:28 PM Eastern Daylight Time	08/02/2014 08:09:30 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-022 (PPO)	01	04		1			H5525	022	0	2015	Select counties in Kentucky		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	023	0	1	04	01	H5525_023_0	5		1	07/10/2014	2015.02	07/10/2014 01:45:02 PM Eastern Daylight Time	08/02/2014 08:08:53 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-023 (PPO)	01	04		1			H5525	023	0	2015	Select counties in West Virginia		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	024	0	1	04	01	H5525_024_0	4		1	08/06/2014	2015.01	08/06/2014 04:01:31 PM Eastern Daylight Time	08/05/2014 09:40:20 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-024 (PPO)	01	04		1			H5525	024	0	2015	Central Georgia Metro Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	025	0	1	04	01	H5525_025_0	4		1	08/06/2014	2015.01	08/06/2014 04:02:01 PM Eastern Daylight Time	08/05/2014 09:40:55 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-025 (PPO)	01	04		1			H5525	025	0	2015	Outstate South Carolina Metro Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	026	0	1	04	01	H5525_026_0	4		1	08/06/2014	2015.01	08/06/2014 04:02:25 PM Eastern Daylight Time	08/05/2014 11:17:50 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-026 (PPO)	01	04		1			H5525	026	0	2015	Outstate North Carolina Metro Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	027	0	1	04	01	H5525_027_0	3		1	07/10/2014	2015.02	07/10/2014 01:02:44 PM Eastern Daylight Time	08/02/2014 01:33:03 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-027 (PPO)	01	04		1			H5525	027	0	2015	Select counties in Montana		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	029	0	1	04	01	H5525_029_0	3		1	07/10/2014	2015.02	07/10/2014 02:48:59 PM Eastern Daylight Time	08/03/2014 06:14:48 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	HumanaChoice H5525-029 (PPO)	01	04		1			H5525	029	0	2015	Allegheny county		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5525	809	0	1	04	01	H5525_809_0	2		1	05/28/2014	2015.02	05/28/2014 02:42:00 PM Eastern Daylight Time	07/14/2014 09:54:47 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5525	809	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5525	810	0	1	04	01	H5525_810_0	2		1	05/27/2014	2015.02	05/27/2014 02:44:14 PM Eastern Daylight Time	07/14/2014 09:55:02 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5525	810	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5525	811	0	1	04	01	H5525_811_0	2		1	05/23/2014	2015.02	05/23/2014 01:59:35 PM Eastern Daylight Time	07/14/2014 09:55:17 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5525	811	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5525	812	0	2	04	01	H5525_812_0	2		1	05/28/2014	2015.02	05/28/2014 02:59:24 PM Eastern Daylight Time	07/14/2014 09:55:34 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5525	812	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5525	813	0	2	04	01	H5525_813_0	2		1	05/28/2014	2015.02	05/28/2014 02:59:34 PM Eastern Daylight Time	07/14/2014 09:55:50 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5525	813	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5525	814	0	2	04	01	H5525_814_0	2		1	05/28/2014	2015.02	05/28/2014 02:59:46 PM Eastern Daylight Time	07/14/2014 09:56:06 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5525	814	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5525	815	0	1	04	01	H5525_815_0	2		1	05/28/2014	2015.02	05/28/2014 02:14:15 PM Eastern Daylight Time	07/14/2014 09:56:23 AM Eastern Daylight Time				07/14/2014 01:06:16 PM Eastern Daylight Time	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Humana Benefit Plan of Illinois, Inc.	www.humana-medicare.com	Humana Medicare Employer - Walmart (PPO)	01	04		1			H5525	815	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5526	004	0	1	04	01	H5526_004_0	6		1	07/17/2014	2015.02	07/17/2014 03:41:03 PM Eastern Daylight Time	08/04/2014 11:06:46 PM Eastern Daylight Time	08/04/2014 10:51:38 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	BlueCross BlueShield Forever Blue Medicare PPO 751 (PPO)	01	04		1			H5526	004	0	2015	Western New York		2	3042	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5526	014	0	1	04	01	H5526_014_0	6		1	07/17/2014	2015.02	07/17/2014 03:41:14 PM Eastern Daylight Time	08/04/2014 11:05:56 PM Eastern Daylight Time	08/04/2014 10:50:58 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	BlueShield Forever Blue Medicare PPO 750 (PPO)	01	04		1			H5526	014	0	2015	Northeastern New York		2	367	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5526	016	0	1	04	01	H5526_016_0	7		1	07/17/2014	2015.02	07/17/2014 03:41:27 PM Eastern Daylight Time	08/04/2014 11:05:14 PM Eastern Daylight Time	08/04/2014 10:50:12 PM Eastern Daylight Time			08/06/2014 12:03:24 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/medicare	Forever Blue Medicare PPO Value (PPO)	01	04		1			H5526	016	0	2015	Western New York		2	3676	2			2							www.bcbswny.com/medicare	www.bcbswny.com/medicare	www.bcbswny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5526	017	0	1	04	01	H5526_017_0	8		1	07/17/2014	2015.02	07/17/2014 03:41:34 PM Eastern Daylight Time	08/06/2014 06:18:08 AM Eastern Daylight Time	08/08/2014 03:43:22 PM Eastern Daylight Time			08/08/2014 04:01:35 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bsneny.com/medicare	Forever Blue Medicare PPO Value (PPO)	01	04		1			H5526	017	0	2015	Northeastern New York		2	3380	2			2							www.bsneny.com/medicare	www.bsneny.com/medicare	www.bsneny.com/medicare	(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5526	806	0	1	04	01	H5526_806_0	2		1	06/01/2014	2015.02	06/01/2014 08:50:58 AM Eastern Daylight Time	06/02/2014 04:46:02 PM Eastern Daylight Time				06/02/2014 10:17:32 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/www.bsneny.com/www.healthnowny.org	PPO Group (MA Only) CY (PPO)	01	04		1			H5526	806	0	2015	Western and Northeastern New York		1	4240	2			2							www.bcbswny.com/www.bsneny.com/www.healthnowny.org	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237										(711)-		(711)-		(711)-		(711)-										2					2					
H5526	808	0	1	04	01	H5526_808_0	2		1	06/01/2014	2015.02	06/01/2014 08:51:14 AM Eastern Daylight Time	06/02/2014 04:46:40 PM Eastern Daylight Time				06/02/2014 10:17:32 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	BCBS of WNY/BS of NENY/HealthNow New York Inc.	www.bcbswny.com/www.bsneny.com/www.healthnowny.org	PPO Group (MA-PD) CY (PPO)	01	04		1			H5526	808	0	2015	Western and Northeastern New York		1	4240	2			2							www.bcbswny.com/www.bsneny.com/www.healthnowny.org	http://www.bcbswny.com/pharmacy	www.bcbswny.com	(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(800)329-2792		(800)329-2792		(855)215-9237		(855)215-9237		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	001	0	1	04	01	H5528_001_0	3		1	05/28/2014	2015.01	05/28/2014 03:58:33 PM Eastern Daylight Time	06/02/2014 02:01:43 PM Eastern Daylight Time				09/18/2014 03:58:29 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth PPO I (PPO)	01	04		1			H5528	001	0	2015	Counties of New York City		2	2092	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					
H5528	004	0	1	04	01	H5528_004_0	3		1	05/28/2014	2015.01	05/28/2014 01:05:01 PM Eastern Daylight Time	06/02/2014 02:02:01 PM Eastern Daylight Time				09/18/2014 03:58:29 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth PPO I (PPO)	01	04		1			H5528	004	0	2015	Nassau & Westchester Counties		2	1593	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					
H5528	009	0	1	04	01	H5528_009_0	3		1	05/28/2014	2015.01	05/28/2014 04:38:44 PM Eastern Daylight Time	06/02/2014 02:02:12 PM Eastern Daylight Time				09/18/2014 03:58:29 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth PPO I (PPO)	01	04		1			H5528	009	0	2015	Suffolk County		2	2668	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					
H5528	018	0	1	04	01	H5528_018_0	8	2	1	08/05/2014	2015.01	08/05/2014 12:22:16 PM Eastern Daylight Time	08/05/2014 12:30:12 PM Eastern Daylight Time	08/05/2014 12:30:51 PM Eastern Daylight Time			09/18/2014 04:05:03 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Dual Eligible (PPO SNP)	01	04		1			H5528	018	0	2015	NYC, Nasssau, Suffolk, Westchester		2	36643	2			1	3		1	4				www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	022	0	1	04	01	H5528_022_0	5		1	05/28/2014	2015.01	05/28/2014 04:37:57 PM Eastern Daylight Time	08/05/2014 12:31:18 PM Eastern Daylight Time	08/05/2014 12:31:27 PM Eastern Daylight Time			09/18/2014 04:11:43 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	022	0	2015	Counties of New York City		2	1231	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	023	0	1	04	01	H5528_023_0	5		1	05/28/2014	2015.01	05/28/2014 04:37:40 PM Eastern Daylight Time	08/05/2014 12:31:56 PM Eastern Daylight Time	08/05/2014 12:32:05 PM Eastern Daylight Time			09/18/2014 04:11:43 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	023	0	2015	Counties of New York City		2	6388	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	024	0	1	04	01	H5528_024_0	5		1	05/28/2014	2015.01	05/28/2014 04:37:23 PM Eastern Daylight Time	08/05/2014 12:32:29 PM Eastern Daylight Time	08/05/2014 12:32:37 PM Eastern Daylight Time			09/18/2014 04:11:43 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	024	0	2015	Counties of New York City		2	1078	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	025	0	1	04	01	H5528_025_0	5		1	05/28/2014	2015.01	05/28/2014 04:37:07 PM Eastern Daylight Time	08/05/2014 12:33:04 PM Eastern Daylight Time	08/05/2014 12:33:13 PM Eastern Daylight Time			09/18/2014 04:11:43 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	025	0	2015	Queens and Nassau County		2	12806	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	026	0	1	04	01	H5528_026_0	5		1	05/28/2014	2015.01	05/28/2014 04:36:49 PM Eastern Daylight Time	08/05/2014 12:33:44 PM Eastern Daylight Time	08/05/2014 12:33:52 PM Eastern Daylight Time			09/18/2014 04:11:43 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Advantage (PPO)	01	04		1			H5528	026	0	2015	Suffolk and Westchester Counties		2	19885	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5528	804	0	1	04	01	H5528_804_0	4		1	07/11/2014	2015.01	07/11/2014 09:01:21 AM Eastern Daylight Time	06/02/2014 02:05:05 PM Eastern Daylight Time				09/18/2014 04:16:33 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access (PPO)	01	04		1			H5528	804	0	2015	United States		1	12	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-										2					2					
H5528	807	0	1	04	01	H5528_807_0	3		1	05/28/2014	2015.01	05/28/2014 09:20:09 AM Eastern Daylight Time	06/02/2014 02:05:37 PM Eastern Daylight Time				09/18/2014 04:16:33 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PPO	www.emblemhealth.com/our-plans/medicare	EmblemHealth Group Access Rx (PPO)	01	04		1			H5528	807	0	2015	United States		1	4608	2			2								www.emblemhealth.com	www.emblemhealth.com	(866)557-7300		(866)557-7300		(800)447-9169		(800)447-9169		(877)444-7097		(877)444-7097		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5529	008	1	1	04	01	H5529_008_1	12		1	07/18/2014	2015.01	07/18/2014 12:44:41 PM Central Daylight Time	08/06/2014 02:52:45 AM Eastern Daylight Time	08/01/2014 05:31:09 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H5529	008	1	2015	Select Counties in Ohio	Segment 001	2	3005	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5529	008	2	1	04	01	H5529_008_2	13		1	07/18/2014	2015.01	07/18/2014 12:44:58 PM Central Daylight Time	08/06/2014 02:52:49 AM Eastern Daylight Time	08/01/2014 05:31:10 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H5529	008	2	2015	Select Counties in Ohio	Segment 002	2	3277	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5529	009	1	1	04	01	H5529_009_1	12		1	07/18/2014	2015.01	07/18/2014 12:45:24 PM Central Daylight Time	08/06/2014 02:52:54 AM Eastern Daylight Time	08/01/2014 05:31:11 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Select (PPO)	01	04		1			H5529	009	1	2015	Select Counties in Ohio	Segment 001	2	592	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5529	009	2	1	04	01	H5529_009_2	12		1	07/18/2014	2015.01	07/18/2014 12:45:36 PM Central Daylight Time	08/06/2014 02:52:58 AM Eastern Daylight Time	08/01/2014 05:31:12 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Select (PPO)	01	04		1			H5529	009	2	2015	Select Counties in Ohio	Segment 002	2	5922	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(800)467-1199		(800)467-1199		(800)797-1765		(800)797-1765		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5529	804	0	1	04	01	H5529_804_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:10 PM Pacific Daylight Time	07/15/2014 03:57:53 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5529	804	0	2015	Ohio		1	987	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H5529	805	0	1	04	01	H5529_805_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:13 PM Pacific Daylight Time	07/15/2014 03:58:04 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5529	805	0	2015	Ohio		1	742	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H5529	806	0	1	04	01	H5529_806_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:18 PM Pacific Daylight Time	07/15/2014 03:58:17 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	COMMUNITY INSURANCE COMPANY	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5529	806	0	2015	Ohio		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H5530	006	1	1	04	01	H5530_006_1	14		1	07/01/2014	2015.01	07/01/2014 10:19:02 AM Central Daylight Time	08/06/2014 01:26:52 PM Eastern Daylight Time	08/06/2014 01:30:04 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H5530	006	1	2015	Select Counties in Kentucky	Select Counties in Kentucky	2	662	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-1759		(800)797-1759		(800)797-1759		(800)797-1759		(800)467-1199		(800)467-1199		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5530	006	2	1	04	01	H5530_006_2	14		1	07/01/2014	2015.01	07/01/2014 10:19:09 AM Central Daylight Time	08/06/2014 01:27:05 PM Eastern Daylight Time	08/06/2014 01:30:17 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H5530	006	2	2015	Select Counties in Kentucky	Select Counties in Kentucky	2	3753	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-1759		(800)797-1759		(800)797-1759		(800)797-1759		(800)467-1199		(800)467-1199		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5530	804	0	1	04	01	H5530_804_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:26 PM Pacific Daylight Time	07/15/2014 03:58:30 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5530	804	0	2015	Kentucky		1	469	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H5530	805	0	1	04	01	H5530_805_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:29 PM Pacific Daylight Time	07/15/2014 03:58:41 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5530	805	0	2015	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H5530	806	0	1	04	01	H5530_806_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:33 PM Pacific Daylight Time	07/15/2014 03:59:00 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H5530	806	0	2015	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H5530	808	0	2	04	01	H5530_808_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:37 PM Pacific Daylight Time	07/15/2014 03:59:11 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF KENTUCKY, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		2	1		H5530	808	0	2015	Kentucky		1	50	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(866)845-8609		(866)845-8609		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H5532	001	0	1	04	01	H5532_001_0	2		1	05/30/2014	2015.02	05/30/2014 04:29:33 PM Central Daylight Time	08/04/2014 02:40:24 PM Central Daylight Time	07/31/2014 03:27:02 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (PPO)	01	04		1			H5532	001	0	2015	Charlotte,Hernando,Hillsborough,Lee,Pasco,Pinellas		2		2			2							www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	www.AARPMedicarePlans.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5533	003	0	1	04	01	H5533_003_0	5		1	06/02/2014	2015.01	06/02/2014 08:21:32 AM Eastern Daylight Time	08/06/2014 10:35:38 AM Eastern Daylight Time	07/31/2014 04:45:58 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible with Rx (PPO)	01	04		1			H5533	003	0	2015	Western Pennsylvania		2	12500	2			2							www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					
H5533	005	0	1	04	01	H5533_005_0	5		1	06/02/2014	2015.01	06/02/2014 08:23:56 AM Eastern Daylight Time	08/06/2014 10:36:31 AM Eastern Daylight Time	07/31/2014 04:46:06 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO Rx Enhanced (PPO)	01	04		1			H5533	005	0	2015	Western PA		2	500	2			2							www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					
H5533	006	0	1	04	01	H5533_006_0	6		1	06/02/2014	2015.01	06/02/2014 08:22:07 AM Eastern Daylight Time	08/06/2014 10:37:23 AM Eastern Daylight Time	07/31/2014 04:46:15 PM Eastern Daylight Time			08/06/2014 04:10:45 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC for Life PPO High Deductible with Rx (PPO)	01	04		1			H5533	006	0	2015	Lancaster County		2	175	2			2							www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		2					2					
H5533	801	0	1	04	01	H5533_801_0	3		1	05/19/2014	2015.01	05/19/2014 02:54:33 PM Eastern Daylight Time	06/02/2014 04:00:04 PM Eastern Daylight Time				06/02/2014 05:34:56 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PPO)	01	04		1			H5533	801	0	2015	Western Pennsylvania		1		2			2							www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629										1	1	011100011000000000100110001000000100	2		1					
H5533	802	0	1	04	01	H5533_802_0	3		1	05/19/2014	2015.01	05/19/2014 02:55:29 PM Eastern Daylight Time	06/02/2014 04:00:44 PM Eastern Daylight Time				06/02/2014 05:34:56 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	802	0	2015	Western Pennsylvania		1		2			2							www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	011100011000000000100110001000000100	2		1					
H5533	803	0	1	04	01	H5533_803_0	3		1	05/19/2014	2015.01	05/19/2014 02:56:24 PM Eastern Daylight Time	06/02/2014 04:01:32 PM Eastern Daylight Time				06/02/2014 05:34:56 PM Eastern Daylight Time	UPMC HEALTH NETWORK, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group Rx (PPO)	01	04		1			H5533	803	0	2015	Western Pennsylvania		1		2			2							www.upmchealthplan.com/medicare/	http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html	(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629		1	1	011100011000000000100110001000000100	2		1					
H5549	002	0	1	01	01	H5549_002_0	7	2	1	08/06/2014	2015.01	08/06/2014 11:24:17 AM Eastern Daylight Time	08/05/2014 03:39:33 PM Eastern Daylight Time	08/01/2014 03:15:01 PM Eastern Daylight Time			08/06/2014 12:12:01 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Preferred (HMO SNP)	01	01		1			H5549	002	0	2015	New York Metro Area		2	16663	2			1	3		1	2				http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5549	003	0	1	01	01	H5549_003_0	6	2	1	08/05/2014	2015.01	08/05/2014 10:31:21 AM Eastern Daylight Time	08/05/2014 03:41:16 PM Eastern Daylight Time	08/01/2014 03:18:25 PM Eastern Daylight Time			08/06/2014 12:12:01 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Total (HMO SNP)	01	01		1			H5549	003	0	2015	New York Metro Area		2	63	2			1	3		1	5				http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(866)597-6674		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5549	004	0	1	01	01	H5549_004_0	6		1	08/06/2014	2015.01	08/06/2014 11:26:03 AM Eastern Daylight Time	08/06/2014 11:12:53 AM Eastern Daylight Time	08/01/2014 03:24:16 PM Eastern Daylight Time			08/06/2014 12:12:01 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Enhanced (HMO)	01	01		1			H5549	004	0	2015	New York Metro Area		2	2691	2			2								http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5549	006	0	1	01	01	H5549_006_0	6	2	1	08/01/2014	2015.01	08/01/2014 02:07:40 PM Eastern Daylight Time	08/05/2014 03:43:00 PM Eastern Daylight Time	08/01/2014 03:27:44 PM Eastern Daylight Time			08/06/2014 12:12:01 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Maximum (HMO SNP)	01	01		1			H5549	006	0	2015	New York Metro Area		2	368	2			1	3		1	5				http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5549	008	0	1	01	01	H5549_008_0	7		1	08/01/2014	2015.01	08/01/2014 02:06:47 PM Eastern Daylight Time	08/05/2014 03:44:10 PM Eastern Daylight Time	08/01/2014 03:34:23 PM Eastern Daylight Time			08/06/2014 12:12:01 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE Medicare Classic (HMO)	01	01		1			H5549	008	0	2015	New York Metro Area		2	1896	2			2								http://www.vnsnychoice.org/	http://www.vnsnychoice.org/	(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(866)783-1444		(866)783-1444		(866)867-0047		(866)867-0047		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5576	008	0	1	01	01	H5576_008_0	9		1	08/05/2014	2015.02	08/05/2014 01:31:20 PM Central Daylight Time	08/06/2014 02:25:10 PM Central Daylight Time	08/06/2014 02:24:49 PM Central Daylight Time			08/06/2014 02:59:33 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA4 Vantage TRADITIONAL PLUS (HMO)	01	01		1			H5576	008	0	2015	North Louisiana, Central Louisiana and Baton Rouge		2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	012	0	1	02	01	H5576_012_0	10		1	08/05/2014	2015.02	08/05/2014 01:31:56 PM Central Daylight Time	08/06/2014 02:25:11 PM Central Daylight Time	08/06/2014 02:24:49 PM Central Daylight Time			08/06/2014 02:59:33 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA6 Vantage CAPITOL (HMO-POS)	01	02		1			H5576	012	0	2015	Baton Rouge area		2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	016	1	1	02	01	H5576_016_1	12		1	08/11/2014	2015.02	08/11/2014 12:54:37 PM Central Daylight Time	08/06/2014 02:25:11 PM Central Daylight Time	08/06/2014 02:24:49 PM Central Daylight Time			08/11/2014 12:58:51 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA3 Vantage PREMIUM (HMO-POS)	01	02		1			H5576	016	1	2015	North Louisiana, Central Louisiana	Ouachita	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	016	2	1	02	01	H5576_016_2	12		1	08/11/2014	2015.02	08/11/2014 12:54:55 PM Central Daylight Time	08/06/2014 02:25:11 PM Central Daylight Time	08/06/2014 02:24:49 PM Central Daylight Time			08/11/2014 12:58:51 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA3 Vantage PREMIUM (HMO-POS)	01	02		1			H5576	016	2	2015	North Louisiana, Central Louisiana	North Louisiana, Central Louisiana	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	017	1	1	02	01	H5576_017_1	13		1	08/12/2014	2015.02	08/12/2014 12:39:46 PM Central Daylight Time	08/12/2014 09:44:21 AM Central Daylight Time	08/06/2014 02:24:50 PM Central Daylight Time			08/12/2014 12:41:22 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA0 Vantage ZERO (HMO-POS)	01	02		1			H5576	017	1	2015	North Louisiana, Central Louisiana	Ouachita	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	017	2	1	02	01	H5576_017_2	11		1	08/05/2014	2015.02	08/05/2014 01:38:43 PM Central Daylight Time	08/06/2014 02:25:12 PM Central Daylight Time	08/06/2014 02:24:50 PM Central Daylight Time			08/06/2014 02:59:33 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA0 Vantage ZERO (HMO-POS)	01	02		1			H5576	017	2	2015	North Louisiana, Central Louisiana	North Louisiana, Central Louisiana	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	018	1	1	02	01	H5576_018_1	12		1	08/11/2014	2015.02	08/11/2014 12:55:12 PM Central Daylight Time	08/06/2014 02:25:12 PM Central Daylight Time	08/06/2014 02:24:50 PM Central Daylight Time			08/11/2014 12:58:51 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA1 Vantage VALUE (HMO-POS)	01	02		1			H5576	018	1	2015	North Louisiana, Central Louisiana	Ouachita	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	018	2	1	02	01	H5576_018_2	12		1	08/11/2014	2015.02	08/11/2014 12:55:28 PM Central Daylight Time	08/06/2014 02:25:10 PM Central Daylight Time	08/06/2014 02:24:45 PM Central Daylight Time			08/11/2014 12:58:51 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	AAA1 Vantage VALUE (HMO-POS)	01	02		1			H5576	018	2	2015	North Louisiana, Central Louisiana	North Louisiana, Central Louisiana	2		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	801	0	1	02	01	H5576_801_0	5		1	04/22/2014	2015.02	04/22/2014 12:57:01 PM Central Daylight Time	07/28/2014 02:10:24 PM Central Daylight Time				07/31/2014 09:28:24 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MAPD Employer Calendar (HMO-POS)	01	02		1			H5576	801	0	2015	Louisiana		1		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	802	0	1	02	01	H5576_802_0	6		1	04/22/2014	2015.02	04/22/2014 12:57:48 PM Central Daylight Time	07/28/2014 02:08:26 PM Central Daylight Time				07/31/2014 09:28:24 AM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MAPD Emp Non-Calendar (HMO-POS)	01	02		1			H5576	802	0	2015	Louisiana		1		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1	(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131		2					2					2
H5576	803	0	1	02	01	H5576_803_0	7		1	04/22/2014	2015.02	04/22/2014 12:57:54 PM Central Daylight Time	06/02/2014 03:51:33 PM Central Daylight Time				06/02/2014 03:51:51 PM Central Daylight Time	VANTAGE HEALTH PLAN, INC.	Vantage Health Plan, Inc.	www.VantageMedicare.com	Vantage - MA Employer Calendar (HMO-POS)	01	02		1			H5576	803	0	2015	Louisiana		1		2			2							www.VantageMedicare.com	www.VantageMedicare.com	www.VantageMedicare.com	(888)823-1910	1	(318)361-0900	1	(888)823-1910	1	(318)361-0900	1									(866)524-5144		(318)361-2131		(866)524-5144		(318)361-2131										2					2					2
H5577	002	0	1	01	01	H5577_002_0	8	1	1	08/06/2014	2015.01	08/06/2014 05:49:02 PM SA Western Standard Time	08/06/2014 05:41:19 PM SA Western Standard Time	08/06/2014 05:52:39 PM SA Western Standard Time			08/06/2014 06:05:26 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Ideal (HMO SNP)	01	01		1			H5577	002	0	2015	Puerto Rico		2	42144	2		1	1	3		1	3		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2
H5577	005	0	1	01	01	H5577_005_0	10		1	08/10/2014	2015.01	08/10/2014 06:28:23 PM SA Western Standard Time	08/11/2014 03:09:46 PM SA Western Standard Time	08/11/2014 03:11:33 PM SA Western Standard Time			08/11/2014 05:16:34 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare InteliCare (HMO)	01	01		1			H5577	005	0	2015	Puerto Rico		2	11168	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2
H5577	008	0	1	02	01	H5577_008_0	10		1	08/06/2014	2015.01	08/06/2014 05:03:32 PM SA Western Standard Time	08/06/2014 05:43:54 PM SA Western Standard Time	08/06/2014 05:51:52 PM SA Western Standard Time			08/06/2014 06:05:26 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Essential (HMO-POS)	01	02		1			H5577	008	0	2015	Puerto Rico		2	62711	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2
H5577	009	0	1	01	01	H5577_009_0	8	1	1	07/11/2014	2015.01	07/11/2014 11:11:30 AM SA Western Standard Time	08/06/2014 05:44:25 PM SA Western Standard Time	08/06/2014 05:52:08 PM SA Western Standard Time			08/06/2014 06:05:26 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Mximo (HMO SNP)	01	01		1			H5577	009	0	2015	Puerto Rico		2	19038	2		1	1	3		1	3		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2
H5577	010	0	1	01	01	H5577_010_0	7	1	1	08/05/2014	2015.01	08/05/2014 03:52:01 PM SA Western Standard Time	08/06/2014 05:45:38 PM SA Western Standard Time	08/06/2014 05:52:26 PM SA Western Standard Time			08/06/2014 06:05:26 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare Platino Superior (HMO SNP)	01	01		1			H5577	010	0	2015	Puerto Rico		2	46089	2		1	1	3		1	3		1	www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					2
H5577	801	0	1	01	01	H5577_801_0	3		1	05/31/2014	2015.01	05/31/2014 04:38:41 PM SA Western Standard Time	07/25/2014 05:20:18 PM SA Western Standard Time				07/25/2014 08:29:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA Group (HMO)	01	01		1			H5577	801	0	2015	Puerto Rico		1	11	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528										(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182										1	1	011111111010100111111111011110000110	2		2					1
H5577	802	0	1	01	01	H5577_802_0	4		1	07/07/2014	2015.01	07/07/2014 08:52:57 AM SA Western Standard Time	07/25/2014 05:20:16 PM SA Western Standard Time				07/25/2014 08:29:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group (C) (HMO)	01	01		1			H5577	802	0	2015	Puerto Rico		1	13169	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					1
H5577	803	0	1	01	01	H5577_803_0	4		1	07/07/2014	2015.01	07/07/2014 08:54:12 AM SA Western Standard Time	07/25/2014 05:19:52 PM SA Western Standard Time				07/25/2014 08:29:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 10 (C) (HMO)	01	01		1			H5577	803	0	2015	Puerto Rico		1	11	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					1
H5577	804	0	1	01	01	H5577_804_0	4		1	07/07/2014	2015.01	07/07/2014 08:55:04 AM SA Western Standard Time	07/25/2014 05:19:26 PM SA Western Standard Time				07/25/2014 08:29:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 20 (C) (HMO)	01	01		1			H5577	804	0	2015	Puerto Rico		1	17189	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					1
H5577	805	0	1	01	01	H5577_805_0	4		1	07/07/2014	2015.01	07/07/2014 08:55:58 AM SA Western Standard Time	07/25/2014 05:19:00 PM SA Western Standard Time				07/25/2014 08:29:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 30 (C) (HMO)	01	01		1			H5577	805	0	2015	Puerto Rico		1	11	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					1
H5577	806	0	1	01	01	H5577_806_0	4		1	07/07/2014	2015.01	07/07/2014 08:56:54 AM SA Western Standard Time	07/25/2014 05:18:22 PM SA Western Standard Time				07/25/2014 08:29:12 PM SA Western Standard Time	MCS ADVANTAGE, INC.	MCS Classicare	www.mcsclassicare.com	MCS Classicare MA-PD Group 40 (C) (HMO)	01	01		1			H5577	806	0	2015	Puerto Rico		1	11	2			2							www.mcsclassicare.com	www.mcsclassicare.com	www.mcsclassicare.com	(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8183		(787)620-2530		(866)627-8181		(787)620-2528		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		(866)627-8182		2					2					1
H5580	001	0	1	01	01	H5580_001_0	8	2	1	08/12/2014	2015.01	08/12/2014 01:50:04 PM Pacific Daylight Time	08/06/2014 12:17:48 PM Pacific Daylight Time	08/06/2014 02:27:07 PM Pacific Daylight Time			08/12/2014 03:20:33 PM Pacific Daylight Time	SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	001	0	2015	Maricopa and Pima Counties		2	11710	2			1	3		1	4			www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5580	004	0	1	01	01	H5580_004_0	9	2	1	08/12/2014	2015.01	08/12/2014 03:12:37 PM Pacific Daylight Time	08/07/2014 07:22:50 AM Pacific Daylight Time	08/06/2014 02:28:27 PM Pacific Daylight Time			08/12/2014 03:20:33 PM Pacific Daylight Time	SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	004	0	2015	Maricopa and Pima Counties		2	5858	2			1	3		1	4			www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5580	005	0	1	01	01	H5580_005_0	8	2	1	08/12/2014	2015.01	08/12/2014 03:13:12 PM Pacific Daylight Time	08/06/2014 12:16:19 PM Pacific Daylight Time	08/06/2014 02:30:26 PM Pacific Daylight Time			08/12/2014 03:20:33 PM Pacific Daylight Time	SOUTHWEST CATHOLIC HEALTH NETWORK CORPORATION	Mercy Care Advantage	www.MercyCareAdvantage.com	Mercy Care Advantage (HMO SNP)	01	01		1			H5580	005	0	2015	Maricopa, Pima and Santa Cruz Counties		2	1137	2			1	3		1	4			www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	www.MercyCareAdvantage.com/members/mca/information	(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(800)624-3879		(602)263-3000		(866)571-5781		(602)414-7630		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5587	002	0	1	01	01	H5587_002_0	6	2	1	08/05/2014	2015.01	08/05/2014 02:52:10 PM US Mountain Standard Time	08/05/2014 01:17:08 PM US Mountain Standard Time	08/05/2014 01:17:08 PM US Mountain Standard Time			08/06/2014 07:23:41 AM US Mountain Standard Time	HEALTH CHOICE ARIZONA, INC.	Health Choice Generations HMO SNP	www.healthchoicegenerations.com	Health Choice Generations (HMO SNP)	01	01		1			H5587	002	0	2015	Counties: APA, CCN, GIL, MAR, MOH, NAV, PIM, PIN		2		2			1	3		1	4			http://www.healthchoicearizona.com/Directory/search.asp?bl=hcg	http://www.hcgenerations.com/index.asp?page=formulary.asp&f=partd	http://www.hcgenerations.com	(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(800)656-8991		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5590	002	0	1	01	01	H5590_002_0	7	2	1	08/05/2014	2015.01	08/05/2014 09:50:34 AM Pacific Daylight Time	08/05/2014 04:03:08 PM Pacific Daylight Time	08/05/2014 03:46:34 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	BRIDGEWAY HEALTH SOLUTIONS	Bridgeway Health Solutions	http://advantage.bridgewayhs.com	Bridgeway Health Solutions Advantage (HMO SNP)	01	01		1			H5590	002	0	2015	Maricopa County		2	2187	2			1	3		1	4			http://advantage.bridgewayhs.com/	http://medicare.bridgewayhs.com/home/prescription-drug-part-d-benefit-information/formulary/	http://medicare.bridgewayhs.com/home/prescription-drug-part-d-benefit-information/	(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(877)935-8020		(800)367-8939		(800)367-8939		(800)367-8939		(800)367-8939		(800)367-8939		(800)367-8939		(800)367-8939		(800)367-8939		2					2					2
H5591	001	0	1	02	01	H5591_001_0	7		1	08/06/2014	2015.02	08/06/2014 06:42:37 PM Eastern Daylight Time	08/05/2014 08:43:41 PM Eastern Daylight Time	08/05/2014 08:43:54 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	001	0	2015	Aroo,Fran,Han,Knx,Linc,Oxf,Pen,Som,Pisc,Wald,Wash		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5591	003	0	1	01	01	H5591_003_0	6		1	07/23/2014	2015.02	07/23/2014 10:36:20 AM Eastern Daylight Time	06/23/2014 11:20:19 AM Eastern Daylight Time				07/23/2014 11:03:56 AM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Value (HMO)	01	01		1			H5591	003	0	2015	State of Maine		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423										(711)-		(711)-		(711)-		(711)-										2					2					2
H5591	005	0	1	02	01	H5591_005_0	7		1	08/06/2014	2015.02	08/06/2014 06:43:15 PM Eastern Daylight Time	08/05/2014 08:44:07 PM Eastern Daylight Time	08/05/2014 08:44:25 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	005	0	2015	Hillsborough, Strafford, NH		2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5591	006	1	1	02	01	H5591_006_1	7		1	08/06/2014	2015.02	08/06/2014 06:43:36 PM Eastern Daylight Time	08/05/2014 08:44:41 PM Eastern Daylight Time	08/05/2014 08:44:53 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	1	2015	Andr,Cumb,Kenn,Saga, York	Andr,Cumb	2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5591	006	2	1	02	01	H5591_006_2	6		1	08/06/2014	2015.02	08/06/2014 06:52:37 PM Eastern Daylight Time	08/05/2014 08:45:09 PM Eastern Daylight Time	08/05/2014 08:45:26 PM Eastern Daylight Time			08/06/2014 07:28:42 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime (HMO-POS)	01	02		1			H5591	006	2	2015	Andr,Cumb,Kenn,Saga, York	Kenn,Saga, York	2		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5591	801	0	1	02	01	H5591_801_0	4		1	06/02/2014	2015.02	06/02/2014 08:19:46 AM Eastern Daylight Time	06/02/2014 05:10:32 PM Eastern Daylight Time				06/04/2014 01:33:51 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	801	0	2015	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100110100010001100000100	2		1	2		2		1
H5591	802	0	1	02	01	H5591_802_0	4		1	06/02/2014	2015.02	06/02/2014 08:20:10 AM Eastern Daylight Time	06/02/2014 05:06:12 PM Eastern Daylight Time				06/04/2014 01:33:51 PM Eastern Daylight Time	MARTIN'S POINT GENERATIONS, LLC	Martin's Point Generations Advantage	www.martinspoint.org/medicare	Martin's Point Generations Advantage Prime Group (HMO-POS)	01	02		1			H5591	802	0	2015	National		1		2			2							www.martinspoint.org/medicare	www.martinspoint.org/medicare	www.martinspoint.org/medicare	(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(866)544-7504		(866)544-7504		(888)640-4423		(888)640-4423		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100110100010001100000100	2		1	2		2		1
H5594	001	0	1	02	01	H5594_001_0	8		1	08/05/2014	2015.01	08/05/2014 11:11:04 AM Eastern Daylight Time	08/04/2014 05:18:50 PM Eastern Daylight Time	08/01/2014 10:06:46 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO-POS)	01	02		1			H5594	001	0	2015	Select Counties in Florida		2	1	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	002	0	1	02	01	H5594_002_0	8		1	08/05/2014	2015.01	08/05/2014 11:11:21 AM Eastern Daylight Time	08/04/2014 05:19:58 PM Eastern Daylight Time	08/01/2014 10:07:16 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO-POS)	01	02		1			H5594	002	0	2015	Select Counties in Florida		2	1	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	016	0	1	01	01	H5594_016_0	8	2	1	08/05/2014	2015.01	08/05/2014 11:11:34 AM Eastern Daylight Time	08/04/2014 05:20:46 PM Eastern Daylight Time	08/01/2014 10:07:50 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Partial (HMO SNP)	01	01		1			H5594	016	0	2015	Select Counties in Florida		2	1	2			1	3		1	4			www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	017	0	1	01	01	H5594_017_0	8	2	1	08/05/2014	2015.01	08/05/2014 11:11:50 AM Eastern Daylight Time	08/04/2014 05:21:32 PM Eastern Daylight Time	08/01/2014 10:08:22 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Emerald Full (HMO SNP)	01	01		1			H5594	017	0	2015	Select Counties in Florida		2	1	2			1	3		1	5			www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	019	0	1	02	01	H5594_019_0	8		1	08/05/2014	2015.01	08/05/2014 11:12:12 AM Eastern Daylight Time	08/04/2014 05:22:18 PM Eastern Daylight Time	08/01/2014 10:08:54 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Platinum Plan (HMO-POS)	01	02		1			H5594	019	0	2015	Select Counties in Florida		2	1	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	022	0	1	02	01	H5594_022_0	8		1	08/05/2014	2015.01	08/05/2014 11:12:26 AM Eastern Daylight Time	08/04/2014 05:23:08 PM Eastern Daylight Time	08/01/2014 10:09:24 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO-POS)	01	02		1			H5594	022	0	2015	Select Counties in Florida		2	1	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	026	0	1	02	01	H5594_026_0	8		1	08/05/2014	2015.01	08/05/2014 11:12:42 AM Eastern Daylight Time	08/04/2014 05:24:14 PM Eastern Daylight Time	08/01/2014 10:09:56 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Rewards Plan (HMO-POS)	01	02		1			H5594	026	0	2015	Select Counties in Florida		2	1	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	028	0	1	02	01	H5594_028_0	8		1	08/05/2014	2015.01	08/05/2014 11:12:54 AM Eastern Daylight Time	08/04/2014 05:25:04 PM Eastern Daylight Time	08/01/2014 10:10:28 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO-POS SNP)	01	02		1			H5594	028	0	2015	Select Counties in Florida		2	1	2			1	4		1		00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	029	0	1	02	01	H5594_029_0	8		1	08/05/2014	2015.01	08/05/2014 11:13:12 AM Eastern Daylight Time	08/04/2014 05:25:58 PM Eastern Daylight Time	08/01/2014 10:11:00 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO-POS SNP)	01	02		1			H5594	029	0	2015	Select Counties in Florida		2	1	2			1	4		1		00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	030	0	1	02	01	H5594_030_0	8		1	08/05/2014	2015.01	08/05/2014 11:13:25 AM Eastern Daylight Time	08/04/2014 05:26:48 PM Eastern Daylight Time	08/01/2014 10:11:32 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards (HMO-POS SNP)	01	02		1			H5594	030	0	2015	Select Counties in Florida		2	1	2			1	4		1		00000000000000000010		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	031	0	1	02	01	H5594_031_0	9		1	09/10/2014	2015.01	09/10/2014 09:36:59 AM Eastern Daylight Time	08/04/2014 05:27:46 PM Eastern Daylight Time	08/01/2014 10:12:04 AM Eastern Daylight Time			09/17/2014 12:44:50 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Diamond Rewards COPD (HMO-POS SNP)	01	02		1			H5594	031	0	2015	Select Counties in Florida		2	1	2			1	4		1		00000000000100000000		www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5594	032	0	1	02	01	H5594_032_0	8		1	08/05/2014	2015.01	08/05/2014 11:14:04 AM Eastern Daylight Time	08/05/2014 11:51:30 AM Eastern Daylight Time	08/01/2014 10:12:36 AM Eastern Daylight Time			08/05/2014 01:20:17 PM Eastern Daylight Time	OPTIMUM HEALTHCARE, INC.	Optimum HealthCare, Inc.	www.YourOptimumHealthcare.com	Optimum Gold Plus Plan (HMO-POS)	01	02		1			H5594	032	0	2015	Select Counties in Florida		2	1	2			2							www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	www.youroptimumhealthcare.com	(866)245-5360		(866)245-5360		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(866)245-5360		(352)688-9131		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		(800)955-8771		2					2					2
H5608	001	0	1	01	01	H5608_001_0	12	2	1	08/06/2014	2015.01	08/06/2014 02:08:54 PM Mountain Daylight Time	08/06/2014 01:58:14 PM Mountain Daylight Time	08/05/2014 04:47:32 PM Mountain Daylight Time			08/06/2014 04:04:53 PM Mountain Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	http://www.denverhealthmedicalplan.org	Denver Health Medicare Choice (HMO SNP)	01	01		1			H5608	001	0	2015	Denver County		2	1430	2			1	3		1	2			http://denverhealthmedicalplan.org/find-a-doctor--provider.aspx	https://mp.medimpact.com/mp/secure/LaunchProductFrameset.jsp	https://mp.medimpact.com/mp/secure/LaunchProductFrameset.jsp	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		2					2					2
H5608	002	0	1	01	01	H5608_002_0	11		1	07/10/2014	2015.01	07/10/2014 07:06:24 AM Mountain Daylight Time	08/06/2014 02:03:54 PM Mountain Daylight Time	08/05/2014 04:48:08 PM Mountain Daylight Time			08/06/2014 04:04:53 PM Mountain Daylight Time	DENVER HEALTH MEDICAL PLAN, INC.	Denver Health Medical Plan, Inc.	http://www.denverhealthmedicalplan.org	Denver Health Medicare Select (HMO)	01	01		1			H5608	002	0	2015	Denver County		2	2435	2			2							http://denverhealthmedicalplan.org/find-a-doctor--provider.aspx	https://mp.medimpact.com/mp/secure/LaunchProductFrameset.jsp	https://mp.medimpact.com/mp/secure/LaunchProductFrameset.jsp	(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(877)956-2111		(303)602-2111		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		(866)538-5288		(303)602-2129		2					2					2
H5609	001	0	1	01	01	H5609_001_0	4		1	08/05/2014	2015.01	08/05/2014 12:39:47 PM Pacific Daylight Time	08/06/2014 01:26:26 PM Pacific Daylight Time	08/06/2014 01:26:27 PM Pacific Daylight Time			08/06/2014 01:43:07 PM Pacific Daylight Time	GEMCARE HEALTH PLAN INC.	GEMCARE Health Plan	www.gemcarehealthplan.com	GEMCare Medicare Plus (HMO)	01	01		1			H5609	001	0	2015	Kern County		2		2			2							www.gemcarehealthplan.com	www.gemcarehealthplan.com	www.gemcarehealthplan.com	(877)697-2464		(661)716-8800		(877)697-2464		(661)716-8800		(877)697-2464		(661)716-8800		(877)697-2464		(661)716-8800		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		2					2					2
H5609	004	0	1	01	01	H5609_004_0	3		1	08/05/2014	2015.01	08/05/2014 12:40:26 PM Pacific Daylight Time	08/06/2014 01:26:28 PM Pacific Daylight Time	08/06/2014 01:26:20 PM Pacific Daylight Time			08/06/2014 01:51:11 PM Pacific Daylight Time	GEMCARE HEALTH PLAN INC.	GEMCARE Health Plan	www.gemcarehealthplan.com	Physicians Choice Medicare Plus (HMO)	01	01		1			H5609	004	0	2015	San Luis Obispo/Santa Barbara Counties (Partial)		2		2			2							www.gemcarehealthplan.com	www.gemcarehealthplan.com	www.gemcarehealthplan.com	(877)744-2668		(877)744-2668		(877)744-2668		(877)744-2668		(877)744-2668		(877)744-2668		(877)744-2668		(877)744-2668		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		2					2					2
H5609	801	0	1	01	01	H5609_801_0	5		1	05/22/2014	2015.01	05/22/2014 03:57:38 PM Pacific Daylight Time	05/31/2014 06:55:20 PM Pacific Daylight Time				06/02/2014 01:39:18 PM Pacific Daylight Time	GEMCARE HEALTH PLAN INC.	GEMCARE Health Plan	www.gemcarehealthplan.com	GEMCARE Medicare Plus ES Plan (HMO)	01	01		1			H5609	801	0	2015	Kern (Full), SLO/Santa Barbara/Ventura (Partial)		1		2			2							www.gemcarehealthplan.com	www.gemcarehealthplan.com	www.gemcarehealthplan.com	(877)697-2464		(661)716-8800		(877)697-2464		(661)716-8800		(877)697-2464		(661)716-8800		(877)697-2464		(661)716-8800		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		(888)833-9312		2					2					2
H5610	001	0	1	20	08	H5610_001_0	1		1	05/20/2014	2015.01	05/20/2014 02:11:48 PM Eastern Daylight Time		05/19/2014 08:49:25 AM Eastern Daylight Time			05/20/2014 02:12:37 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	08	20		1			H5610	001	0	2015	Kent County		2		2			2								www.care-resources.org	www.care-resources.org									(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(616)913-2006		(800)649-3777		(616)913-2006												
H5610	003	0	1	20	08	H5610_003_0	1		1	05/20/2014	2015.01	05/20/2014 01:14:10 PM Eastern Daylight Time		05/19/2014 08:49:25 AM Eastern Daylight Time			05/20/2014 02:12:37 PM Eastern Daylight Time	CARE RESOURCES	Care Resources	www.care-resources.org	Care Resources (PACE)	08	20		1			H5610	003	0	2015	Kent County		2		2			2								www.care-resources.org	www.care-resources.org									(800)610-6299		(616)913-2006		(800)610-6299		(616)913-2006										(800)649-3777		(616)913-2006		(800)649-3777		(616)913-2006												
H5619	001	0	1	01	01	H5619_001_0	3		1	08/02/2014	2015.02	08/02/2014 10:03:45 AM Eastern Daylight Time	08/04/2014 11:50:10 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-001 (HMO)	01	01		1			H5619	001	0	2015	Southern Maine Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5619	003	0	1	01	01	H5619_003_0	6	2	1	07/10/2014	2015.02	07/10/2014 02:17:35 PM Eastern Daylight Time	08/04/2014 11:49:46 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H5619-003 (HMO SNP)	01	01		1			H5619	003	0	2015	Select Counties in Maine		2		2			1	3		1	1			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5619	007	0	1	01	01	H5619_007_0	3		1	07/10/2014	2015.02	07/10/2014 02:21:14 PM Eastern Daylight Time	08/04/2014 11:49:21 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-007 (HMO)	01	01		1			H5619	007	0	2015	Select Counties in Maine and New Hampshire		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5619	009	0	1	01	01	H5619_009_0	5	2	1	08/02/2014	2015.02	08/02/2014 10:07:47 AM Eastern Daylight Time	08/04/2014 11:48:49 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H5619-009 (HMO SNP)	01	01		1			H5619	009	0	2015	Mid Maine Area		2		2			1	3		1	5			www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5619	011	0	1	01	01	H5619_011_0	3		1	07/10/2014	2015.02	07/10/2014 02:22:18 PM Eastern Daylight Time	08/04/2014 11:59:54 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Gold Plus H5619-011 (HMO)	01	01		1			H5619	011	0	2015	Select Counties in Maine		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5619	802	0	1	01	01	H5619_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:54:38 PM Eastern Daylight Time	07/14/2014 11:05:26 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H5619	802	0	2015	Select Counties in Maine and New Hampshire		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H5619	803	0	1	01	01	H5619_803_0	3		1	05/23/2014	2015.02	05/23/2014 02:55:23 PM Eastern Daylight Time	07/14/2014 11:06:09 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	ARCADIAN HEALTH PLAN, INC.	Arcadian Health Plan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H5619	803	0	2015	Select Counties in Maine and New Hampshire		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H5628	001	0	1	01	01	H5628_001_0	9	2	1	07/07/2014	2015.01	07/07/2014 08:58:54 AM Pacific Daylight Time	08/05/2014 12:02:00 PM Pacific Daylight Time	08/05/2014 09:37:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5628	001	0	2015	Northern/ Central/ Southern Utah		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(888)665-1328		(888)665-1328		(866)403-8293		(866)403-8293		(888)665-1328		(888)665-1328		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5628	006	0	1	01	01	H5628_006_0	7	2	1	07/22/2014	2015.01	07/22/2014 02:59:07 PM Pacific Daylight Time	08/05/2014 12:02:00 PM Pacific Daylight Time	08/05/2014 09:37:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Healthy Advantage (HMO SNP)	01	01		1			H5628	006	0	2015	Northern/ Central Utah		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5628	007	0	1	01	01	H5628_007_0	6		1	08/05/2014	2015.01	08/05/2014 08:47:34 AM Pacific Daylight Time	08/05/2014 11:10:00 AM Pacific Daylight Time	08/05/2014 09:38:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF UTAH, INC.	Molina Healthcare of Utah	www.molinahealthcare.com/medicare	Healthy Advantage Plus (HMO)	01	01		1			H5628	007	0	2015	Northern/Central Utah		2		2			2							www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(877)644-0344		(877)644-0344		(866)939-5741		(866)939-5741		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5629	001	0	1	20	08	H5629_001_0	1		1	05/30/2014	2015.01	05/30/2014 02:54:01 PM Pacific Daylight Time		05/30/2014 10:15:36 AM Pacific Daylight Time			05/30/2014 02:55:51 PM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	08	20		1			H5629	001	0	2015	San Diego Metro Area		2		2			2								stpaulspace.org	stpaulspace.org									(619)239-6900		(619)239-6900		(619)239-6900		(619)239-6900										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922												
H5629	002	0	1	20	08	H5629_002_0	1		1	05/30/2014	2015.01	05/30/2014 02:54:32 PM Pacific Daylight Time		05/30/2014 10:15:36 AM Pacific Daylight Time			05/30/2014 02:55:51 PM Pacific Daylight Time	COMMUNITY ELDERCARE OF SAN DIEGO	St. Paul's PACE	http://www.stpaulspace.org/	St. Paul's PACE (PACE)	08	20		1			H5629	002	0	2015	San Diego Metro Area		2		2			2								stpaulspace.org	stpaulspace.org									(619)239-6900		(619)239-6900		(619)239-6900		(619)239-6900										(800)735-2922		(800)735-2922		(800)735-2922		(800)735-2922												
H5640	001	0	1	01	01	H5640_001_0	5	2	1	08/06/2014	2015.01	08/06/2014 09:51:59 AM Pacific Daylight Time	08/06/2014 09:30:03 AM Pacific Daylight Time	08/06/2014 09:30:06 AM Pacific Daylight Time			08/06/2014 09:53:26 AM Pacific Daylight Time	IEHP HEALTH ACCESS	IEHP Medicare DualChoice	www.iehp.org	IEHP Medicare DualChoice (HMO SNP)	01	01		1			H5640	001	0	2015	Riverside and San Bernardino Counties		2	10000	2			1	3		1	5			www.iehp.org	www.iehp.org	www.iehp.org	(877)273-4347		(877)273-4347		(877)273-4347		(877)273-4347		(877)273-4347		(877)273-4347		(877)273-4347		(877)273-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		(800)718-4347		2					2					2
H5649	001	0	1	01	01	H5649_001_0	7		1	08/05/2014	2015.01	08/05/2014 02:57:00 PM Eastern Daylight Time	08/05/2014 02:50:34 PM Eastern Daylight Time	08/05/2014 02:51:16 PM Eastern Daylight Time			08/06/2014 10:53:54 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medicare Plan (HMO)	01	01		1			H5649	001	0	2015	Counties:  LA, partial OC, partial SB		2	12394	2			2							www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2
H5649	002	0	1	01	01	H5649_002_0	8	2	1	08/05/2014	2015.01	08/05/2014 02:57:29 PM Eastern Daylight Time	08/05/2014 02:50:45 PM Eastern Daylight Time	08/05/2014 02:51:20 PM Eastern Daylight Time			08/06/2014 10:53:54 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Medi-Medi Plan (HMO SNP)	01	01		1			H5649	002	0	2015	Counties: LA, partial SB		2	9303	2			1	3		1	2			www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2
H5649	004	0	1	01	01	H5649_004_0	7		1	08/05/2014	2015.01	08/05/2014 02:57:41 PM Eastern Daylight Time	08/05/2014 02:51:55 PM Eastern Daylight Time	08/05/2014 02:51:25 PM Eastern Daylight Time			08/06/2014 10:53:54 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Premier Plan (HMO)	01	01		1			H5649	004	0	2015	Counties:  LA, partial OC, partial SB		2	3106	2			2							www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2
H5649	005	0	1	01	01	H5649_005_0	5		1	08/05/2014	2015.01	08/05/2014 03:01:36 PM Eastern Daylight Time	08/05/2014 02:51:12 PM Eastern Daylight Time	08/05/2014 03:04:10 PM Eastern Daylight Time			08/06/2014 10:53:54 AM Eastern Daylight Time	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Central Health Medicare Plan	www.centralhealthplan.com	Central Health Focus Plan (HMO SNP)	01	01		1			H5649	005	0	2015	Central Health Focus Plan		2	1735	2			1	4		1		00000010000000000000		www.centralhealthplan.com/NetworkProviders/Directory.aspx	www.centralhealthplan.com/Benefits/Formulary.aspx	www.centralhealthplan.com/Benefits/PharmacyList.aspx	(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(866)314-2427		(626)388-2390		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		(888)205-7671		(626)388-2391		2					2					2
H5652	001	0	1	02	01	H5652_001_0	4		1	07/18/2014	2015.02	07/18/2014 09:40:24 AM Central Daylight Time	08/04/2014 03:10:56 PM Central Daylight Time	07/31/2014 03:27:05 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Signature with Drugs (HMO-POS)	01	02		1			H5652	001	0	2015	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		2		2			2							www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5652	002	0	1	02	01	H5652_002_0	3		1	07/18/2014	2015.02	07/18/2014 09:40:33 AM Central Daylight Time	06/27/2014 01:08:28 PM Central Daylight Time				07/18/2014 12:49:44 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Signature without Drugs (HMO-POS)	01	02		1			H5652	002	0	2015	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		2		2			2							www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671										(711)-		(711)-		(711)-		(711)-										2					2					2
H5652	003	0	1	02	01	H5652_003_0	4		1	07/18/2014	2015.02	07/18/2014 09:40:42 AM Central Daylight Time	08/04/2014 04:20:29 PM Central Daylight Time	07/31/2014 03:27:08 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Guardian (HMO-POS SNP)	01	02		1			H5652	003	0	2015	Erickson Campuses - MA, MD, MI, NJ, PA, and VA		2		2			1	1	1	1				www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5652	004	0	1	02	01	H5652_004_0	4		1	07/18/2014	2015.02	07/18/2014 09:41:02 AM Central Daylight Time	08/04/2014 04:20:45 PM Central Daylight Time	07/31/2014 03:27:11 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Champion (HMO-POS SNP)	01	02		1			H5652	004	0	2015	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		2		2			1	4		1		00011010000000000000		www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5652	006	0	1	02	01	H5652_006_0	3		1	05/30/2014	2015.02	05/30/2014 04:43:38 PM Central Daylight Time	08/04/2014 03:18:57 PM Central Daylight Time	07/31/2014 03:27:14 PM Central Daylight Time			08/06/2014 10:02:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	Erickson Advantage	www.EricksonAdvantage.com	Erickson Advantage Freedom (HMO-POS)	01	02		1			H5652	006	0	2015	Erickson Campuses - CO,KS,MA,MD,MI,NJ,PA,TX,VA		2		2			2							www.EricksonAdvantage.com	www.EricksonAdvantage.com	www.EricksonAdvantage.com	(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(866)314-8188		(866)314-8188		(866)774-9671		(866)774-9671		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5656	001	0	1	01	01	H5656_001_0	7		1	08/05/2014	2015.01	08/05/2014 05:18:07 PM Central Daylight Time	08/04/2014 03:37:45 PM Central Daylight Time	07/31/2014 04:27:41 PM Central Daylight Time			08/06/2014 09:42:28 AM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.TexanPlus.com	TexanPlus Classic (HMO)	01	01		1			H5656	001	0	2015	Dallas Metroplex Area		2		2			2							www.TexanPlus.com	www.TexanPlus.com	www.TexanPlus.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5656	801	0	1	01	01	H5656_801_0	2		1	05/29/2014	2015.01	05/29/2014 12:00:03 PM Central Daylight Time	05/31/2014 07:34:57 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.Universal-American-Medicare.com	Retiree - MA-PD CY (HMO)	01	01		1			H5656	801	0	2015	Employer Group--North Texas (MAPD--CY)		1		2			2							www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H5656	802	0	1	01	01	H5656_802_0	2		1	05/29/2014	2015.01	05/29/2014 12:00:26 PM Central Daylight Time	05/31/2014 07:35:34 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.Universal-American-Medicare.com	Retiree - MA-PD non-CY (HMO)	01	01		1			H5656	802	0	2015	Employer Group--North Texas (MAPD--non-CY)		1		2			2							www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H5656	803	0	1	01	01	H5656_803_0	2		1	05/29/2014	2015.01	05/29/2014 12:00:48 PM Central Daylight Time	05/31/2014 07:36:02 PM Central Daylight Time				06/02/2014 01:12:09 PM Central Daylight Time	SELECTCARE HEALTH PLANS, INC.	Universal American Corp.	www.Universal-American-Medicare.com	Retiree - MA (HMO)	01	01		1			H5656	803	0	2015	Employer Group--North Texas (MA--CY)		1		2			2							www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	www.Universal-American-Medicare.com	(800)958-2707		(800)958-2707		(866)245-4143		(866)245-4143										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H5685	001	0	1	01	01	H5685_001_0	6	2	1	08/01/2014	2015.01	08/01/2014 01:48:57 PM Eastern Daylight Time	08/04/2014 05:23:25 PM Eastern Daylight Time	08/06/2014 01:49:02 PM Eastern Daylight Time			08/06/2014 05:25:17 PM Eastern Daylight Time	MIDWEST HEALTH PLAN, INC.	Midwest Advantage	www.hap.org/midwest	HAP Midwest Health Plan (HMO SNP)	01	01		1			H5685	001	0	2015	HAP Midwest Advantage of Southeast Michigan		2	1402	2			1	3		1	3		1	www.hap.org/midwest	www.hap.org/midwest	www.hap.org/midwest	(888)654-0706		(313)581-3700		(888)654-0706		(313)581-3700		(888)445-5580		(313)581-3700		(888)654-0706		(313)581-3700		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H5698	028	0	1	01	01	H5698_028_0	6		1	08/04/2014	2015.02	08/04/2014 01:23:32 PM Eastern Daylight Time	08/05/2014 11:31:52 AM Eastern Daylight Time	08/01/2014 11:35:09 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Gold Essential (HMO)	01	01		1			H5698	028	0	2015	Middle and Northern Mississippi		2	21846	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	035	0	1	01	01	H5698_035_0	7		1	07/24/2014	2015.02	07/24/2014 07:33:38 AM Eastern Daylight Time	06/02/2014 05:29:10 PM Eastern Daylight Time				08/11/2014 02:09:22 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Silver Advance (HMO)	01	01		1			H5698	035	0	2015	Counties in AR, MS, SC and TN		2	1440	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794										(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272										2					2					2
H5698	062	0	1	01	01	H5698_062_0	6		1	08/04/2014	2015.02	08/04/2014 01:24:00 PM Eastern Daylight Time	08/05/2014 11:32:05 AM Eastern Daylight Time	08/01/2014 11:35:19 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	Wellcare Emerald Value (HMO)	01	01		1			H5698	062	0	2015	Eastern and Western Tennessee counties		2	3440	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	063	0	1	01	01	H5698_063_0	6		1	08/04/2014	2015.02	08/04/2014 01:24:28 PM Eastern Daylight Time	08/05/2014 11:32:18 AM Eastern Daylight Time	08/01/2014 11:35:28 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	Wellcare Emerald Value (HMO)	01	01		1			H5698	063	0	2015	Middle and Northern Arkansas counties		2	5776	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	128	0	1	01	01	H5698_128_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:33:49 AM Eastern Daylight Time	08/05/2014 11:32:32 AM Eastern Daylight Time	08/01/2014 11:35:38 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Comp Access (HMO SNP)	01	01		1			H5698	128	0	2015	Selected Arkansas counties		2	3899	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	134	0	1	01	01	H5698_134_0	7	2	1	07/24/2014	2015.02	07/24/2014 07:33:58 AM Eastern Daylight Time	08/05/2014 11:32:45 AM Eastern Daylight Time	08/01/2014 11:35:49 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Comp Access (HMO SNP)	01	01		1			H5698	134	0	2015	Selected Mississippi counties		2	7769	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	140	0	1	01	01	H5698_140_0	6	2	1	05/30/2014	2015.02	05/30/2014 11:45:37 AM Eastern Daylight Time	08/05/2014 11:33:00 AM Eastern Daylight Time	08/01/2014 11:35:59 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Comp Access (HMO SNP)	01	01		1			H5698	140	0	2015	Selected Tennessee counties		2	7154	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	158	0	1	01	01	H5698_158_0	6	2	1	05/30/2014	2015.02	05/30/2014 11:45:51 AM Eastern Daylight Time	08/05/2014 11:33:14 AM Eastern Daylight Time	08/01/2014 11:36:09 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Comp Access (HMO SNP)	01	01		1			H5698	158	0	2015	Western South Carolina counties		2	1701	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	159	0	1	01	01	H5698_159_0	6		1	08/04/2014	2015.02	08/04/2014 01:25:07 PM Eastern Daylight Time	08/05/2014 11:33:28 AM Eastern Daylight Time	08/01/2014 11:36:19 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Emerald Value (HMO)	01	01		1			H5698	159	0	2015	Western South Carolina counties		2	2289	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	198	0	1	02	01	H5698_198_0	6		1	08/04/2014	2015.02	08/04/2014 01:25:32 PM Eastern Daylight Time	08/05/2014 11:33:41 AM Eastern Daylight Time	08/01/2014 11:36:29 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Value (HMO-POS)	01	02		1			H5698	198	0	2015	Hinds, Madison, Rankin, Warren		2	69	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	199	0	1	02	01	H5698_199_0	6		1	08/04/2014	2015.02	08/04/2014 01:26:01 PM Eastern Daylight Time	08/05/2014 11:33:54 AM Eastern Daylight Time	08/01/2014 11:36:39 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Dividend (HMO-POS)	01	02		1			H5698	199	0	2015	Large Metropolitan Tennessee counties		2	366	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5698	200	0	1	01	01	H5698_200_0	6	2	1	05/31/2014	2015.02	05/31/2014 07:39:46 PM Eastern Daylight Time	08/05/2014 11:34:08 AM Eastern Daylight Time	08/01/2014 11:36:49 AM Eastern Daylight Time			08/06/2014 02:37:21 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcare.com	WellCare Access (HMO SNP)	01	01		1			H5698	200	0	2015	Selected Southeastern Mississippi counties		2	92	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(800)316-2273		(800)316-2273		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H5703	001	0	1	01	01	H5703_001_0	3	2	1	07/16/2014	2015.01	07/16/2014 04:34:24 PM Central Daylight Time	08/04/2014 06:16:58 PM Central Daylight Time	08/04/2014 10:03:44 AM Central Daylight Time			08/04/2014 06:29:00 PM Central Daylight Time	SOUTH COUNTRY HEALTH ALLIANCE	South Country Health Alliance	www.mnscha.org	AbilityCare (HMO SNP)	01	01		1			H5703	001	0	2015	Select Counties in Minnesota		2	571	1	1		1	3		1	5			www.mnscha.org	www.mnscha.org	www.mnscha.org	(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(866)567-7242		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5746	015	1	1	01	01	H5746_015_1	9		1	08/05/2014	2015.01	08/05/2014 06:40:50 PM Pacific Daylight Time	08/06/2014 11:22:06 AM Pacific Daylight Time	08/06/2014 01:05:27 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5746	015	1	2015	Albuquerque and Central New Mexico	Albuquerque Metro area	2	1120	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5746	015	2	1	01	01	H5746_015_2	9		1	08/05/2014	2015.01	08/05/2014 06:41:42 PM Pacific Daylight Time	08/06/2014 11:22:29 AM Pacific Daylight Time	08/06/2014 01:05:31 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Amerigroup Community Care of New Mexico	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5746	015	2	2015	Albuquerque and Central New Mexico	Central New Mexico	2	488	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5749	001	0	1	02	01	H5749_001_0	3		1	05/30/2014	2015.02	05/30/2014 11:02:03 AM Central Daylight Time	08/04/2014 05:41:50 PM Central Daylight Time	07/31/2014 03:27:17 PM Central Daylight Time			08/06/2014 11:12:26 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plus Plan 1 (HMO-POS)	01	02		1			H5749	001	0	2015	Johnson, Cass, Jackson, and Lafayette counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5774	003	0	1	01	01	H5774_003_0	8		1	07/23/2014	2015.01	07/23/2014 11:20:59 AM SA Western Standard Time	06/28/2014 03:18:00 PM SA Western Standard Time				07/23/2014 11:38:52 AM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Basic (HMO)	01	01		1			H5774	003	0	2015	Puerto Rico		2	277	2			2							www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2					2
H5774	005	0	1	01	01	H5774_005_0	9		1	08/06/2014	2015.01	08/06/2014 06:15:15 PM SA Western Standard Time	08/06/2014 04:56:22 PM SA Western Standard Time	08/01/2014 09:11:12 AM SA Western Standard Time			08/06/2014 06:37:32 PM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Royal (HMO)	01	01		1			H5774	005	0	2015	Puerto Rico		2	27209	2			2							www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5774	008	0	1	01	01	H5774_008_0	10		1	07/23/2014	2015.01	07/23/2014 11:14:10 AM SA Western Standard Time	08/06/2014 04:57:00 PM SA Western Standard Time	08/01/2014 09:11:22 AM SA Western Standard Time			08/06/2014 06:37:32 PM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Classic (HMO)	01	01		1			H5774	008	0	2015	Puerto Rico		2	842	2			2							www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5774	009	0	1	01	01	H5774_009_0	9		1	08/06/2014	2015.01	08/06/2014 06:30:13 PM SA Western Standard Time	08/06/2014 05:12:24 PM SA Western Standard Time	08/01/2014 09:11:32 AM SA Western Standard Time			08/06/2014 06:37:32 PM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Vital (HMO SNP)	01	01		1			H5774	009	0	2015	Puerto Rico		2	1830	2			1	4		1		00000010000000000000		www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5774	019	0	1	01	01	H5774_019_0	10	1	1	08/06/2014	2015.01	08/06/2014 06:28:01 PM SA Western Standard Time	08/06/2014 04:58:54 PM SA Western Standard Time	08/01/2014 09:11:42 AM SA Western Standard Time			08/06/2014 06:37:32 PM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Platino Optimum (HMO SNP)	01	01		1			H5774	019	0	2015	Puerto Rico		2	42833	2		1	1	3		1	3		1	www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5774	022	0	1	01	01	H5774_022_0	8		1	08/06/2014	2015.01	08/06/2014 06:32:27 PM SA Western Standard Time	08/06/2014 05:13:02 PM SA Western Standard Time	08/01/2014 09:11:50 AM SA Western Standard Time			08/06/2014 06:37:32 PM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Vital Plus (HMO SNP)	01	01		1			H5774	022	0	2015	Puerto Rico		2	203	2			1	4		1		00000000000000000010		www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5774	802	0	1	01	01	H5774_802_0	6		1	07/23/2014	2015.01	07/23/2014 11:10:49 AM SA Western Standard Time	06/28/2014 03:24:02 PM SA Western Standard Time				07/23/2014 11:38:52 AM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Royal A (HMO)	01	01		1			H5774	802	0	2015	Puerto Rico		1	99	2			2							www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420										(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520										2					2					2
H5774	806	0	1	01	01	H5774_806_0	6		1	07/23/2014	2015.01	07/23/2014 11:11:23 AM SA Western Standard Time	06/28/2014 03:24:46 PM SA Western Standard Time				07/23/2014 11:38:52 AM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Royal B (HMO)	01	01		1			H5774	806	0	2015	Puerto Rico		1	935	2			2							www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5774	808	0	1	01	01	H5774_808_0	6		1	07/23/2014	2015.01	07/23/2014 11:11:54 AM SA Western Standard Time	06/28/2014 03:25:34 PM SA Western Standard Time				07/23/2014 11:38:52 AM SA Western Standard Time	AMERICAN HEALTH, INC.	AHM	www.ahmpr.com	Royal C (HMO)	01	01		1			H5774	808	0	2015	Puerto Rico		1	99	2			2							www.ahmpr.com	www.ahmpr.com	www.ahmpr.com	(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(888)620-1919		(888)620-1919		(866)620-2420		(866)620-2420		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		(866)620-2520		2					2					2
H5779	001	0	1	01	01	H5779_001_0	8	2	1	08/06/2014	2015.01	08/06/2014 03:12:15 PM Central Daylight Time	08/11/2014 02:24:56 PM Central Daylight Time	08/06/2014 04:28:41 PM Central Daylight Time			08/11/2014 02:26:39 PM Central Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Advantage Plan of Illinois (HMO SNP)	01	01		1			H5779	001	0	2015	Chicago Metro Area, Northern IL and Central IL		2	1417	2			1	3		1	5			www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5779	002	0	1	01	01	H5779_002_0	6		1	08/06/2014	2015.01	08/06/2014 03:12:54 PM Central Daylight Time	08/06/2014 05:28:41 PM Eastern Daylight Time	08/06/2014 05:28:41 PM Eastern Daylight Time			08/06/2014 07:27:16 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Prime (HMO)	01	01		1			H5779	002	0	2015	Chicago Metro Area, Northern IL and Central IL		2	345	2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5786	001	0	1	01	01	H5786_001_0	8	2	1	08/06/2014	2015.01	08/06/2014 05:31:49 PM Eastern Daylight Time	08/11/2014 02:24:57 PM Central Daylight Time	08/06/2014 04:28:42 PM Central Daylight Time			08/11/2014 02:26:39 PM Central Daylight Time	MERIDIAN HEALTH PLAN OF IOWA, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Advantage Plan of Iowa (HMO SNP)	01	01		1			H5786	001	0	2015	Jones, Linn, Polk and Scott Counties		2	526	2			1	3		1	5			www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5786	002	0	1	01	01	H5786_002_0	6		1	08/06/2014	2015.01	08/06/2014 03:10:54 PM Central Daylight Time	08/06/2014 05:28:42 PM Eastern Daylight Time	08/06/2014 05:28:39 PM Eastern Daylight Time			08/06/2014 07:27:16 PM Eastern Daylight Time	MERIDIAN HEALTH PLAN OF IOWA, INC.	Meridian Health Plan	www.MedicareMeridian.com	Meridian Prime (HMO)	01	01		1			H5786	002	0	2015	Jones, Linn, Polk and Scott Counties		2	125	2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(877)902-6784		(877)902-6784		(855)647-0075		(855)647-0075		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5793	001	0	1	01	01	H5793_001_0	4		1	08/03/2014	2015.01	08/03/2014 02:00:02 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time	08/01/2014 10:21:17 AM Eastern Daylight Time			08/06/2014 10:40:53 AM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5793	001	0	2015	Inland CT		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5793	008	0	1	01	01	H5793_008_0	4		1	08/03/2014	2015.01	08/03/2014 02:05:58 PM Eastern Daylight Time	08/04/2014 05:05:14 PM Eastern Daylight Time	08/01/2014 10:21:27 AM Eastern Daylight Time			08/06/2014 10:40:53 AM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H5793	008	0	2015	Connecticut		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5793	010	0	1	01	01	H5793_010_0	4		1	08/03/2014	2015.01	08/03/2014 02:09:34 PM Eastern Daylight Time	08/04/2014 05:06:06 PM Eastern Daylight Time	08/01/2014 10:21:37 AM Eastern Daylight Time			08/06/2014 10:40:53 AM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Elite Plan (HMO)	01	01		1			H5793	010	0	2015	Shoreline CT		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5793	801	0	1	01	01	H5793_801_0	2		1	05/23/2014	2015.01	05/23/2014 02:36:36 PM Eastern Daylight Time	07/24/2014 03:36:15 PM Eastern Daylight Time				07/24/2014 03:45:20 PM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5793	801	0	2015	Connecticut		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H5793	802	0	1	01	01	H5793_802_0	1		1	05/23/2014	2015.01	05/23/2014 03:12:09 PM Eastern Daylight Time	05/30/2014 11:07:06 PM Eastern Daylight Time				05/31/2014 11:14:23 AM Eastern Daylight Time	AETNA HEALTH, INC. (CT)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5793	802	0	2015	Connecticut		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H5810	001	0	1	01	01	H5810_001_0	9	2	1	07/31/2014	2015.01	07/31/2014 02:10:15 PM Pacific Daylight Time	08/05/2014 11:10:00 AM Pacific Daylight Time	08/05/2014 09:38:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5810	001	0	2015	Southern California		2		2			1	3		1	5			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-0898		(800)665-0898		(866)403-8293		(866)403-8293		(800)665-0898		(800)665-0898		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5810	007	0	1	01	01	H5810_007_0	10	2	1	07/09/2014	2015.01	07/09/2014 12:55:48 PM Pacific Daylight Time	08/05/2014 11:11:00 AM Pacific Daylight Time	08/05/2014 09:38:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5810	007	0	2015	Sacramento County		2		2			1	3		1	5			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-0898		(800)665-0898		(866)403-8293		(866)403-8293		(800)665-0898		(800)665-0898		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5813	003	0	1	01	01	H5813_003_0	4		1	07/11/2014	2015.01	07/11/2014 09:54:06 AM Eastern Daylight Time	08/04/2014 08:19:30 PM Eastern Daylight Time	08/01/2014 10:21:47 AM Eastern Daylight Time			08/06/2014 10:40:53 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Standard Plan (HMO)	01	01		1			H5813	003	0	2015	New Castle and Kent Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5813	006	0	1	01	01	H5813_006_0	4		1	06/01/2014	2015.01	06/01/2014 03:12:35 AM Eastern Daylight Time	08/04/2014 08:18:32 PM Eastern Daylight Time	08/01/2014 10:21:57 AM Eastern Daylight Time			08/06/2014 10:40:53 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Premier Plan (HMO)	01	01		1			H5813	006	0	2015	New Castle and Kent Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5813	801	0	1	01	01	H5813_801_0	1		1	05/23/2014	2015.01	05/23/2014 10:07:11 PM Eastern Daylight Time	05/30/2014 11:12:04 PM Eastern Daylight Time				05/31/2014 11:14:23 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5813	801	0	2015	Delaware		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H5813	802	0	1	01	01	H5813_802_0	1		1	05/23/2014	2015.01	05/23/2014 10:08:41 PM Eastern Daylight Time	05/30/2014 11:20:40 PM Eastern Daylight Time				05/31/2014 11:14:23 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5813	802	0	2015	Delaware		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H5817	009	0	1	01	01	H5817_009_0	8	2	1	07/17/2014	2015.01	07/17/2014 03:01:21 PM Pacific Daylight Time	08/06/2014 11:22:53 AM Pacific Daylight Time	08/06/2014 01:05:35 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H5817	009	0	2015	Houston, Dallas, San Antonio, Lubbock Areas		2	22449	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	018	0	1	01	01	H5817_018_0	8		1	08/05/2014	2015.01	08/05/2014 06:53:07 PM Pacific Daylight Time	08/06/2014 11:23:14 AM Pacific Daylight Time	08/06/2014 01:05:39 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic Select + Rx (HMO)	01	01		1			H5817	018	0	2015	Bexar County		2	500	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	019	0	1	01	01	H5817_019_0	8		1	08/05/2014	2015.01	08/05/2014 06:59:16 PM Pacific Daylight Time	08/06/2014 11:23:38 AM Pacific Daylight Time	08/06/2014 01:05:43 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic Select + Rx (HMO)	01	01		1			H5817	019	0	2015	El Paso County		2	500	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	020	1	1	01	01	H5817_020_1	8		1	08/05/2014	2015.01	08/05/2014 07:06:42 PM Pacific Daylight Time	08/06/2014 11:24:00 AM Pacific Daylight Time	08/06/2014 01:05:47 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5817	020	1	2015	Houston, Dallas, San Antonio, Lubbock Areas	Houston Metro Area	2	6117	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	020	2	1	01	01	H5817_020_2	8		1	08/05/2014	2015.01	08/05/2014 07:11:50 PM Pacific Daylight Time	08/06/2014 11:24:24 AM Pacific Daylight Time	08/06/2014 01:05:52 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5817	020	2	2015	Houston, Dallas, San Antonio, Lubbock Areas	Fort Worth Area	2	894	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	020	3	1	01	01	H5817_020_3	8		1	08/05/2014	2015.01	08/05/2014 10:24:04 PM Pacific Daylight Time	08/06/2014 11:24:48 AM Pacific Daylight Time	08/06/2014 01:05:55 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5817	020	3	2015	Houston, Dallas, San Antonio, Lubbock Areas	San Antonio Area	2	1305	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	020	4	1	01	01	H5817_020_4	8		1	08/05/2014	2015.01	08/05/2014 10:28:55 PM Pacific Daylight Time	08/06/2014 11:25:09 AM Pacific Daylight Time	08/06/2014 01:06:00 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5817	020	4	2015	Houston, Dallas, San Antonio, Lubbock Areas	El Paso Area	2	2785	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	020	5	1	01	01	H5817_020_5	8		1	08/05/2014	2015.01	08/05/2014 10:32:38 PM Pacific Daylight Time	08/06/2014 11:25:32 AM Pacific Daylight Time	08/06/2014 01:06:04 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5817	020	5	2015	Houston, Dallas, San Antonio, Lubbock Areas	Lubbock County	2	775	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5817	020	6	1	01	01	H5817_020_6	8		1	08/05/2014	2015.01	08/05/2014 10:35:36 PM Pacific Daylight Time	08/06/2014 11:25:56 AM Pacific Daylight Time	08/06/2014 01:06:07 PM Pacific Daylight Time			08/06/2014 05:33:36 PM Pacific Daylight Time	AMERIGROUP TEXAS, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H5817	020	6	2015	Houston, Dallas, San Antonio, Lubbock Areas	Austin Area	2	162	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H5822	001	0	1	20	08	H5822_001_0	1		1	05/21/2014	2015.01	05/21/2014 12:02:07 PM Central Daylight Time		05/19/2014 03:00:15 PM Central Daylight Time			05/21/2014 12:03:46 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Dual Eligibles (PACE)	08	20		1			H5822	001	0	2015	Counties: DG, JA, JF, OS, PT, SN, WB		2		2			2								www.midlandcc.org	www.midlandcc.org									(800)491-3691		(785)232-2044	1082	(800)491-3691		(785)232-2044										(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044												
H5822	002	0	1	20	08	H5822_002_0	1		1	05/21/2014	2015.01	05/21/2014 12:02:38 PM Central Daylight Time		05/19/2014 03:00:15 PM Central Daylight Time			05/21/2014 12:03:46 PM Central Daylight Time	MIDLAND CARE CONNECTION	Midland Care PACE	www.midlandcc.org	Midland Care Connection - Medicare Only (PACE)	08	20		1			H5822	002	0	2015	Counties: DG, JA, JF, OS, PT, SN, WB		2		2			2								www.midlandcc.org	www.midlandcc.org									(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044										(800)491-3691		(785)232-2044		(800)491-3691		(785)232-2044												
H5823	006	0	1	01	01	H5823_006_0	9	2	1	08/05/2014	2015.01	08/05/2014 08:50:03 AM Pacific Daylight Time	08/05/2014 11:11:00 AM Pacific Daylight Time	08/05/2014 09:39:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF WASHINGTON, INC.	Molina Healthcare of Washington, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5823	006	0	2015	Western and Eastern Washington		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-1029		(800)665-1029		(866)403-8293		(866)403-8293		(800)665-1029		(800)665-1029		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5826	005	0	1	01	01	H5826_005_0	12	2	1	08/05/2014	2015.01	08/05/2014 02:07:19 PM Pacific Daylight Time	08/05/2014 12:42:16 PM Pacific Daylight Time	08/05/2014 12:42:18 PM Pacific Daylight Time			08/06/2014 10:34:25 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Special Needs Plan (HMO SNP)	01	01		1			H5826	005	0	2015	Eastern and Western Washington State		2	7200	2			1	3		1	3		2	www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5826	006	0	1	01	01	H5826_006_0	12		1	07/17/2014	2015.01	07/17/2014 10:59:17 AM Pacific Daylight Time	08/11/2014 06:34:30 AM Pacific Daylight Time				08/11/2014 12:30:25 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Plan (HMO)	01	01		1			H5826	006	0	2015	Western Washington and Spokane Counties		2	370	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247										(711)-		(711)-		(711)-		(711)-										2					2					2
H5826	008	0	1	01	01	H5826_008_0	15		1	07/17/2014	2015.01	07/17/2014 11:00:22 AM Pacific Daylight Time	08/11/2014 05:31:34 AM Pacific Daylight Time	08/11/2014 12:25:19 PM Pacific Daylight Time			08/11/2014 12:30:25 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	01	01		1			H5826	008	0	2015	Western Washington and Spokane Counties		2	4000	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5826	009	0	1	01	01	H5826_009_0	12		1	07/17/2014	2015.01	07/17/2014 11:01:26 AM Pacific Daylight Time	08/05/2014 12:42:17 PM Pacific Daylight Time	08/05/2014 12:42:20 PM Pacific Daylight Time			08/06/2014 10:34:25 AM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Pharmacy Plan (HMO)	01	01		1			H5826	009	0	2015	Eastern and Western Washington State		2	3800	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5826	010	0	1	01	01	H5826_010_0	15		1	07/17/2014	2015.01	07/17/2014 11:02:15 AM Pacific Daylight Time	08/11/2014 05:28:09 AM Pacific Daylight Time	08/11/2014 12:25:42 PM Pacific Daylight Time			08/11/2014 12:30:25 PM Pacific Daylight Time	COMMUNITY HEALTH PLAN OF WASHINGTON	Community HealthFirst Medicare Advantage Plan	http://healthfirst.chpw.org/	Community HealthFirst MA Extra Plan (HMO)	01	01		1			H5826	010	0	2015	Western Washington, Spokane and Yakima Counties		2	2700	2			2							www.healthfirst.chpw.org	www.healthfirst.chpw.org	www.healthfirst.chpw.org	(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(800)942-0247		(800)942-0247		(800)944-1247		(800)944-1247		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5832	001	0	1	01	01	H5832_001_0	4		1	08/03/2014	2015.01	08/03/2014 04:36:27 PM Eastern Daylight Time	08/04/2014 05:20:42 PM Eastern Daylight Time	08/01/2014 10:22:07 AM Eastern Daylight Time			08/05/2014 04:13:15 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Value Plan (HMO)	01	01		1			H5832	001	0	2015	Oklahoma County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5832	801	0	1	01	01	H5832_801_0	1		1	05/23/2014	2015.01	05/23/2014 10:10:31 PM Eastern Daylight Time	05/30/2014 06:37:26 PM Eastern Daylight Time				05/31/2014 11:14:23 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H5832	801	0	2015	Oklahoma		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H5832	802	0	1	01	01	H5832_802_0	1		1	05/23/2014	2015.01	05/23/2014 10:11:49 PM Eastern Daylight Time	05/30/2014 06:50:06 PM Eastern Daylight Time				05/31/2014 11:14:23 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H5832	802	0	2015	Oklahoma		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H5852	001	0	1	01	01	H5852_001_0	6		1	08/05/2014	2015.01	08/05/2014 03:11:48 PM Pacific Daylight Time	08/05/2014 03:01:47 PM Pacific Daylight Time	08/05/2014 03:01:47 PM Pacific Daylight Time			08/06/2014 03:49:41 AM Pacific Daylight Time	AIDS HEALTHCARE FOUNDATION	AHF	www.php-ca.org	PHP (HMO SNP)	01	01		1			H5852	001	0	2015	Los Angeles County, California		2	1193	2			1	4		1		00000000001000000000		www.php-ca.org/consider-php/provider-pharmacy-networks	www.php-ca.org/for-members/drug-benefit/formulary	www.php-ca.org/consider-php/provider-pharmacy-networks	(800)263-0067		(800)263-0067		(800)263-0067		(800)263-0067		(888)436-5018		(888)436-5018		(800)263-0067		(800)263-0067		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5854	007	0	1	01	01	H5854_007_0	13		1	07/01/2014	2015.01	07/01/2014 12:11:16 PM Pacific Daylight Time	08/05/2014 11:53:11 PM Pacific Daylight Time	08/01/2014 02:31:15 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H5854	007	0	2015	Hartford County		2	567	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5854	008	0	1	01	01	H5854_008_0	9	2	1	08/04/2014	2015.01	08/04/2014 09:46:47 AM Pacific Daylight Time	08/06/2014 11:26:19 AM Pacific Daylight Time	08/06/2014 01:06:15 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H5854	008	0	2015	Hartford, Litchfield, Middlesex, New Haven,Tolland		2	233	2			1	3		1	5			www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5854	009	0	1	01	01	H5854_009_0	13		1	07/01/2014	2015.01	07/01/2014 12:11:29 PM Pacific Daylight Time	08/05/2014 11:53:16 PM Pacific Daylight Time	08/01/2014 02:31:15 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Value (HMO)	01	01		1			H5854	009	0	2015	Fairfield, Litchfield, and New Haven		2	709	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(866)673-4157		(866)673-4157		(800)797-0984		(800)797-0984		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5854	801	0	1	01	01	H5854_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:38:40 AM Pacific Daylight Time	07/15/2014 01:23:58 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	801	0	2015	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H5854	803	0	1	01	01	H5854_803_0	8		1	05/31/2014	2015.01	05/31/2014 11:38:50 AM Pacific Daylight Time	07/15/2014 01:24:04 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	803	0	2015	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H5854	805	0	1	01	01	H5854_805_0	8		1	05/31/2014	2015.01	05/31/2014 11:38:59 AM Pacific Daylight Time	07/15/2014 01:24:10 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H5854	805	0	2015	Connecticut		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(866)220-9827		(866)220-9827		(800)409-7056		(800)409-7056		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H5859	001	0	1	02	01	H5859_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:00:33 AM Pacific Daylight Time	08/06/2014 07:26:54 AM Pacific Daylight Time	08/06/2014 07:26:53 AM Pacific Daylight Time			08/06/2014 02:53:59 PM Pacific Daylight Time	HEALTH PLAN OF CAREOREGON, INC.	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Plus (HMO-POS SNP)	01	02		1			H5859	001	0	2015	Portland/Salem Area, Northwest and Southern Oregon		2	11097	2			1	3		1	3		2	http://www.careoregonadvantage.org	http://www.careoregon.org/Members/MedicareMembers/PharmacyDrugInformation.aspx	http://www.careoregon.org/Members/MedicareMembers/PharmacyDrugInformation.aspx	(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H5859	003	0	1	02	01	H5859_003_0	8		1	08/05/2014	2015.01	08/05/2014 11:01:20 AM Pacific Daylight Time	08/06/2014 07:26:53 AM Pacific Daylight Time	08/06/2014 07:26:53 AM Pacific Daylight Time			08/06/2014 02:53:59 PM Pacific Daylight Time	HEALTH PLAN OF CAREOREGON, INC.	CareOregon Advantage	www.careoregonadvantage.org	CareOregon Advantage Star (HMO-POS)	01	02		1			H5859	003	0	2015	Portland/Salem Area, Northwest and Southern Oregon		2	1351	2			2							http://www.careoregonadvantage.org	http://www.careoregon.org/Members/MedicareMembers/PharmacyDrugInformation.aspx	http://www.careoregon.org/Members/MedicareMembers/PharmacyDrugInformation.aspx	(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(888)712-3258		(503)416-4279		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900		2					2					2
H5883	001	1	1	02	01	H5883_001_1	11		1	07/21/2014	2015.02	07/21/2014 02:35:26 PM Eastern Daylight Time	06/24/2014 01:33:49 PM Eastern Daylight Time				07/22/2014 01:04:05 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	1	2015	Michigan	Region 1	2	291	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2
H5883	001	2	1	02	01	H5883_001_2	10		1	07/21/2014	2015.02	07/21/2014 04:48:10 PM Eastern Daylight Time	06/24/2014 01:33:29 PM Eastern Daylight Time				07/22/2014 01:04:05 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	2	2015	Michigan	Region 2	2	172	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2
H5883	001	3	1	02	01	H5883_001_3	10		1	07/21/2014	2015.02	07/21/2014 04:48:21 PM Eastern Daylight Time	06/24/2014 01:33:08 PM Eastern Daylight Time				07/22/2014 01:04:05 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	3	2015	Michigan	Region 3	2	57	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2
H5883	001	4	1	02	01	H5883_001_4	10		1	07/21/2014	2015.02	07/21/2014 04:48:33 PM Eastern Daylight Time	06/24/2014 01:32:45 PM Eastern Daylight Time				07/22/2014 01:04:05 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	4	2015	Michigan	Region 4	2	192	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2
H5883	001	5	1	02	01	H5883_001_5	10		1	07/21/2014	2015.02	07/21/2014 04:48:53 PM Eastern Daylight Time	06/24/2014 01:34:10 PM Eastern Daylight Time				07/22/2014 01:04:05 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Elements (HMO-POS)	01	02		1			H5883	001	5	2015	Michigan	Region 5	2	408	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										2					2					2
H5883	002	1	1	02	01	H5883_002_1	12		1	07/21/2014	2015.02	07/21/2014 04:42:15 PM Eastern Daylight Time	08/04/2014 04:50:28 PM Eastern Daylight Time	08/04/2014 12:25:58 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	1	2015	Michigan	Region 1	2	5702	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	002	2	1	02	01	H5883_002_2	11		1	07/21/2014	2015.02	07/21/2014 04:49:04 PM Eastern Daylight Time	08/04/2014 04:51:52 PM Eastern Daylight Time	08/04/2014 12:26:08 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	2	2015	Michigan	Region 2	2	2872	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	002	3	1	02	01	H5883_002_3	11		1	07/21/2014	2015.02	07/21/2014 04:49:15 PM Eastern Daylight Time	08/04/2014 04:53:05 PM Eastern Daylight Time	08/04/2014 12:26:16 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	3	2015	Michigan	Region 3	2	1093	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	002	4	1	02	01	H5883_002_4	12		1	07/21/2014	2015.02	07/21/2014 04:49:26 PM Eastern Daylight Time	08/04/2014 04:53:36 PM Eastern Daylight Time	08/04/2014 12:26:25 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	4	2015	Michigan	Region 4	2	3913	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	002	7	1	02	01	H5883_002_7	12		1	07/21/2014	2015.02	07/21/2014 04:49:35 PM Eastern Daylight Time	08/04/2014 04:52:18 PM Eastern Daylight Time	08/04/2014 12:26:34 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Classic (HMO-POS)	01	02		1			H5883	002	7	2015	Michigan	Region 5	2	8217	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	003	1	1	02	01	H5883_003_1	12		1	07/21/2014	2015.02	07/21/2014 04:41:53 PM Eastern Daylight Time	08/04/2014 04:51:28 PM Eastern Daylight Time	08/04/2014 12:26:45 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	1	2015	Michigan	Region 1	2	357	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	003	2	1	02	01	H5883_003_2	11		1	07/21/2014	2015.02	07/21/2014 04:49:51 PM Eastern Daylight Time	08/04/2014 04:50:45 PM Eastern Daylight Time	08/04/2014 12:26:53 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	2	2015	Michigan	Region 2	2	357	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	003	3	1	02	01	H5883_003_3	11		1	07/21/2014	2015.02	07/21/2014 04:50:00 PM Eastern Daylight Time	08/04/2014 04:49:44 PM Eastern Daylight Time	08/04/2014 12:27:02 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	3	2015	Michigan	Region 3	2	116	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	003	4	1	02	01	H5883_003_4	12		1	07/21/2014	2015.02	07/21/2014 04:50:12 PM Eastern Daylight Time	08/04/2014 04:46:36 PM Eastern Daylight Time	08/04/2014 12:27:11 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	4	2015	Michigan	Region 4	2	413	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	003	5	1	02	01	H5883_003_5	12		1	07/21/2014	2015.02	07/21/2014 04:50:22 PM Eastern Daylight Time	08/04/2014 04:45:50 PM Eastern Daylight Time	08/04/2014 12:27:20 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Prestige (HMO-POS)	01	02		1			H5883	003	5	2015	Michigan	Region 5	2	1732	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	004	1	1	02	01	H5883_004_1	11		1	07/21/2014	2015.02	07/21/2014 04:41:09 PM Eastern Daylight Time	08/04/2014 04:45:08 PM Eastern Daylight Time	08/04/2014 12:27:30 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	1	2015	Michigan	Region 1	2	1762	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	004	2	1	02	01	H5883_004_2	10		1	07/21/2014	2015.02	07/21/2014 04:50:32 PM Eastern Daylight Time	08/04/2014 04:44:22 PM Eastern Daylight Time	08/04/2014 12:27:40 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	2	2015	Michigan	Region 2	2	1834	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	004	3	1	02	01	H5883_004_3	10		1	07/21/2014	2015.02	07/21/2014 04:50:41 PM Eastern Daylight Time	08/04/2014 04:43:37 PM Eastern Daylight Time	08/04/2014 12:27:49 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	3	2015	Michigan	Region 3	2	671	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	004	4	1	02	01	H5883_004_4	11		1	07/21/2014	2015.02	07/21/2014 04:50:53 PM Eastern Daylight Time	08/04/2014 04:42:43 PM Eastern Daylight Time	08/04/2014 12:27:59 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	4	2015	Michigan	Region 4	2	1638	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	004	5	1	02	01	H5883_004_5	11		1	07/21/2014	2015.02	07/21/2014 04:51:03 PM Eastern Daylight Time	08/04/2014 04:42:02 PM Eastern Daylight Time	08/04/2014 12:34:11 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO-POS Basic (HMO-POS)	01	02		1			H5883	004	5	2015	Michigan	Region 5	2		2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	006	0	1	01	01	H5883_006_0	12		1	07/21/2014	2015.02	07/21/2014 02:12:57 PM Eastern Daylight Time	08/04/2014 04:41:22 PM Eastern Daylight Time	08/04/2014 12:28:18 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO MyChoice Wellness (HMO)	01	01		1			H5883	006	0	2015	Kent, Muskegon and Oceana Counties		2	1726	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	007	0	1	01	01	H5883_007_0	12		1	07/21/2014	2015.02	07/21/2014 02:13:13 PM Eastern Daylight Time	08/05/2014 10:49:31 AM Eastern Daylight Time	08/04/2014 12:28:27 PM Eastern Daylight Time			08/05/2014 03:38:24 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage HMO ConnectedCare (HMO)	01	01		1			H5883	007	0	2015	Gen, Kzoo, LIv, Oak, Wash, Wayne		2	2200	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(800)450-3680		(800)450-3680		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5883	801	0	1	02	01	H5883_801_0	7		1	05/24/2014	2015.02	05/24/2014 04:26:27 PM Eastern Daylight Time	06/02/2014 09:04:33 PM Eastern Daylight Time				06/02/2014 09:31:54 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage (HMO-POS)	01	02		1			H5883	801	0	2015	Employer Group		1	22150	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111011111000100	1	100001111011011111110110000	1	1	011111111111111111111111111111111100	2		1
H5883	805	0	1	02	01	H5883_805_0	7		1	05/24/2014	2015.02	05/24/2014 04:26:38 PM Eastern Daylight Time	06/02/2014 09:05:04 PM Eastern Daylight Time				06/02/2014 09:31:54 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage (HMO-POS)	01	02		1			H5883	805	0	2015	Employer Group		1	5786	2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111011111000100	1	100001111011011111110110000	1	1	011111111111111111111111111111111100	2		1
H5883	807	0	1	02	01	H5883_807_0	7		1	05/24/2014	2015.02	05/24/2014 04:26:43 PM Eastern Daylight Time	06/02/2014 09:05:35 PM Eastern Daylight Time				06/02/2014 09:31:54 PM Eastern Daylight Time	BLUE CARE NETWORK OF MICHIGAN	Blue Care Network	www.bcbsm.com/bcna	BCN Advantage (HMO-POS)	01	02		1			H5883	807	0	2015	Employer Group		1		2			2							www.bcbsm.com/providersbcna	www.bcbsm.com/formularybcna	www.bcbsm.com/pharmaciesbcna	(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(800)450-3680		(800)450-3680		(866)966-2583		(866)966-2583		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111011111000100	1	100001111011011111110110000	1	1	011111111111111111111111111111111100	2		1
H5887	001	0	1	01	01	H5887_001_0	13		1	08/08/2014	2015.01	08/08/2014 06:53:28 PM SA Western Standard Time	08/08/2014 06:50:50 PM SA Western Standard Time	08/04/2014 03:20:54 PM SA Western Standard Time			08/08/2014 06:54:25 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First Care+Plus (HMO)	01	01		1			H5887	001	0	2015	Entire Island Puerto Rico		2		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		2					2					2
H5887	007	0	1	01	01	H5887_007_0	11		1	08/05/2014	2015.01	08/05/2014 03:49:53 PM SA Western Standard Time	08/02/2014 10:01:48 AM SA Western Standard Time	08/04/2014 03:20:38 PM SA Western Standard Time			08/05/2014 03:55:25 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First+Plus Complete (HMO SNP)	01	01		1			H5887	007	0	2015	Entire Island Puerto Rico		2		2			1	4		1		00000010000000000000		www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		2					2					
H5887	010	0	1	01	01	H5887_010_0	12	1	1	07/24/2014	2015.01	07/24/2014 05:39:51 PM Atlantic Standard Time	08/02/2014 10:01:30 AM SA Western Standard Time	08/04/2014 03:20:18 PM SA Western Standard Time			08/05/2014 03:55:25 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First+Plus Platino (HMO SNP)	01	01		1			H5887	010	0	2015	Entire Island of Puerto Rico		2		2		1	1	3		1	3		1	www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		2					2					2
H5887	012	0	1	01	01	H5887_012_0	11		1	08/05/2014	2015.01	08/05/2014 03:50:04 PM SA Western Standard Time	08/02/2014 10:01:12 AM SA Western Standard Time	08/04/2014 03:19:56 PM SA Western Standard Time			08/05/2014 03:55:25 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First+Plus Smart Premium (HMO)	01	01		1			H5887	012	0	2015	Entire Island of Puerto Rico		2		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		2					2					
H5887	013	0	1	01	01	H5887_013_0	11		1	08/05/2014	2015.01	08/05/2014 03:50:26 PM SA Western Standard Time	08/02/2014 10:00:52 AM SA Western Standard Time	08/04/2014 03:19:36 PM SA Western Standard Time			08/05/2014 03:55:25 PM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	First+Plus Smart Value (HMO)	01	01		1			H5887	013	0	2015	Entire Island of Puerto Rico		2		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		2					2					2
H5887	806	0	1	01	01	H5887_806_0	8		1	06/02/2014	2015.01	06/02/2014 04:53:48 PM SA Western Standard Time	07/02/2014 04:38:18 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 1 (HMO)	01	01		1			H5887	806	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					2
H5887	808	0	1	01	01	H5887_808_0	8		1	05/21/2014	2015.01	05/21/2014 03:27:04 PM SA Western Standard Time	07/02/2014 04:38:36 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 3 (HMO)	01	01		1			H5887	808	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	809	0	1	01	01	H5887_809_0	8		1	05/21/2014	2015.01	05/21/2014 03:27:59 PM SA Western Standard Time	07/02/2014 04:38:52 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 4 (HMO)	01	01		1			H5887	809	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	811	0	1	01	01	H5887_811_0	8		1	05/21/2014	2015.01	05/21/2014 03:28:18 PM SA Western Standard Time	07/02/2014 04:41:12 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 6 (HMO)	01	01		1			H5887	811	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	812	0	1	01	01	H5887_812_0	8		1	05/21/2014	2015.01	05/21/2014 03:28:36 PM SA Western Standard Time	07/02/2014 04:41:28 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 7 (HMO)	01	01		1			H5887	812	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	814	0	1	01	01	H5887_814_0	8		1	05/21/2014	2015.01	05/21/2014 03:28:54 PM SA Western Standard Time	07/02/2014 04:41:44 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 9 (HMO)	01	01		1			H5887	814	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	815	0	1	01	01	H5887_815_0	8		1	05/21/2014	2015.01	05/21/2014 03:29:12 PM SA Western Standard Time	07/02/2014 04:42:00 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 10 (HMO)	01	01		1			H5887	815	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	817	0	1	01	01	H5887_817_0	8		1	05/21/2014	2015.01	05/21/2014 03:29:31 PM SA Western Standard Time	07/02/2014 04:42:16 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 12 (HMO)	01	01		1			H5887	817	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	818	0	1	01	01	H5887_818_0	8		1	05/21/2014	2015.01	05/21/2014 03:29:49 PM SA Western Standard Time	07/02/2014 04:43:38 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 13 (HMO)	01	01		1			H5887	818	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	821	0	1	01	01	H5887_821_0	8		1	05/21/2014	2015.01	05/21/2014 03:30:07 PM SA Western Standard Time	07/02/2014 04:43:54 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 21 (HMO)	01	01		1			H5887	821	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	822	0	1	01	01	H5887_822_0	8		1	05/21/2014	2015.01	05/21/2014 03:30:26 PM SA Western Standard Time	07/02/2014 04:44:10 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 22 (HMO)	01	01		1			H5887	822	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	823	0	1	01	01	H5887_823_0	8		1	05/21/2014	2015.01	05/21/2014 03:30:44 PM SA Western Standard Time	07/02/2014 04:44:28 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 23 (HMO)	01	01		1			H5887	823	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	824	0	1	01	01	H5887_824_0	8		1	05/21/2014	2015.01	05/21/2014 03:31:02 PM SA Western Standard Time	07/02/2014 04:44:44 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 24 (HMO)	01	01		1			H5887	824	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	825	0	1	01	01	H5887_825_0	8		1	05/21/2014	2015.01	05/21/2014 03:31:21 PM SA Western Standard Time	07/02/2014 04:44:58 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 25 (HMO)	01	01		1			H5887	825	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5887	826	0	1	01	01	H5887_826_0	8		1	05/21/2014	2015.01	05/21/2014 03:31:40 PM SA Western Standard Time	07/02/2014 04:45:16 PM SA Western Standard Time				07/08/2014 09:33:32 AM SA Western Standard Time	FIRST MEDICAL HEALTH PLAN, INC.	First Medical Health Plan, Inc.	www.firstpluspr.com	Employer Group Plan 26 (HMO)	01	01		1			H5887	826	0	2015	Entire Island of Puerto Rico		1		2			2							www.firstpluspr.com	http://www.firstpluspr.com	http://www.firstpluspr.com	(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(888)767-7717		(888)767-7717		(877)662-4242		(877)662-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		(877)672-4242		1	1	011100011010000010110111001110000000	2		1					1
H5902	001	0	1	20	08	H5902_001_0	1		1	05/27/2014	2015.01	05/27/2014 01:49:02 PM Eastern Daylight Time		05/22/2014 08:49:11 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Ebensburg	www.seniorlifeebensburg.com	Senior LIFE Altoona Dual Eligible (PACE)	08	20		1			H5902	001	0	2015	Senior LIFE Cambria Blair Indiana County Dual		2	200	2			2								NA	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H5902	002	0	1	20	08	H5902_002_0	1		1	05/27/2014	2015.01	05/27/2014 09:00:28 AM Eastern Daylight Time		05/22/2014 08:49:12 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE ALTOONA, INC.	Senior LIFE Ebensburg	www.seniorlifeebensburg.com	Senior LIFE Altoona Medicare Only (PACE)	08	20		1			H5902	002	0	2015	Senior LIFE Cambria Balir Indiana County MC Only		2	2	2			2								NA	NA									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H5926	001	0	1	01	01	H5926_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 06:29:47 AM Pacific Daylight Time	08/05/2014 12:03:00 PM Pacific Daylight Time	08/05/2014 09:39:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H5926	001	0	2015	East Michigan and West Michigan		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(800)665-3072		(800)665-3072		(866)403-8293		(866)403-8293		(800)665-3072		(800)665-3072		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	001	0	1	01	01	H5928_001_0	9	2	1	08/06/2014	2015.01	08/06/2014 09:27:25 AM Pacific Daylight Time	08/06/2014 06:42:34 AM Pacific Daylight Time	08/05/2014 08:42:45 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	001	0	2015	Los Angeles County		2		2			1	3		1	2			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	004	0	1	01	01	H5928_004_0	10		1	08/06/2014	2015.01	08/06/2014 09:28:29 AM Pacific Daylight Time	08/05/2014 07:23:06 AM Pacific Daylight Time	08/05/2014 08:43:23 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	004	0	2015	Los Angeles and Orange Counties		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	005	0	1	01	01	H5928_005_0	7	2	1	08/06/2014	2015.01	08/06/2014 09:30:32 AM Pacific Daylight Time	08/06/2014 06:46:36 AM Pacific Daylight Time	08/05/2014 08:44:01 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	005	0	2015	Orange and San Bernardino Counties		2		2			1	3		1	2			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	009	0	1	01	01	H5928_009_0	8	2	1	08/06/2014	2015.01	08/06/2014 02:30:29 PM Pacific Daylight Time	08/07/2014 12:42:47 PM Pacific Daylight Time	08/07/2014 12:42:47 PM Pacific Daylight Time			08/07/2014 12:46:59 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	009	0	2015	San Diego County		2		2			1	3		1	2			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	010	0	1	01	01	H5928_010_0	9		1	08/06/2014	2015.01	08/06/2014 02:29:33 PM Pacific Daylight Time	08/07/2014 10:59:02 AM Pacific Daylight Time	08/07/2014 10:59:03 AM Pacific Daylight Time			08/07/2014 11:03:05 AM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	010	0	2015	San Diego County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	012	0	1	01	01	H5928_012_0	8		1	08/06/2014	2015.01	08/06/2014 09:32:28 AM Pacific Daylight Time	08/05/2014 07:39:34 AM Pacific Daylight Time	08/05/2014 08:45:33 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	012	0	2015	San Bernardino and Riverside Counties		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	016	0	1	01	01	H5928_016_0	7		1	08/06/2014	2015.01	08/06/2014 09:33:09 AM Pacific Daylight Time	08/05/2014 07:44:12 AM Pacific Daylight Time	08/05/2014 08:46:08 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	016	0	2015	Santa Clara County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	020	0	1	01	01	H5928_020_0	7		1	08/06/2014	2015.01	08/06/2014 02:31:29 PM Pacific Daylight Time	08/05/2014 07:50:16 AM Pacific Daylight Time	08/05/2014 08:46:43 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	020	0	2015	San Joaquin County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	022	0	1	01	01	H5928_022_0	7		1	08/06/2014	2015.01	08/06/2014 09:35:03 AM Pacific Daylight Time	08/05/2014 07:59:01 AM Pacific Daylight Time	08/05/2014 08:47:18 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	022	0	2015	Stanislaus County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	024	0	1	01	01	H5928_024_0	6		1	08/06/2014	2015.01	08/06/2014 09:35:47 AM Pacific Daylight Time	08/05/2014 08:10:02 AM Pacific Daylight Time	08/05/2014 08:47:55 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	024	0	2015	Alameda County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	025	0	1	01	01	H5928_025_0	6	2	1	08/06/2014	2015.01	08/06/2014 09:37:41 AM Pacific Daylight Time	08/06/2014 06:50:59 AM Pacific Daylight Time	08/05/2014 08:49:40 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st TotalDual Plan (HMO SNP)	01	01		1			H5928	025	0	2015	Alameda, San Francisco and Santa Clara Counties		2		2			1	3		1	2			www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	037	0	1	01	01	H5928_037_0	8		1	08/06/2014	2015.01	08/06/2014 09:42:13 AM Pacific Daylight Time	08/06/2014 08:02:04 AM Pacific Daylight Time	08/05/2014 08:50:08 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Coordinated Choice Plan (HMO)	01	01		1			H5928	037	0	2015	LA, OR, SD, SB, RV, SC, ST, AL, SF, EP, FR		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	038	0	1	01	01	H5928_038_0	5		1	08/06/2014	2015.01	08/06/2014 09:42:40 AM Pacific Daylight Time	08/06/2014 03:27:43 PM Pacific Daylight Time	08/06/2014 03:27:43 PM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	038	0	2015	El Paso County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	042	0	1	01	01	H5928_042_0	8		1	08/06/2014	2015.01	08/06/2014 02:34:15 PM Pacific Daylight Time	08/05/2014 08:05:16 AM Pacific Daylight Time	08/05/2014 08:51:10 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	042	0	2015	San Francisco		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	044	0	1	01	01	H5928_044_0	7		1	08/06/2014	2015.01	08/06/2014 09:44:22 AM Pacific Daylight Time	08/06/2014 06:54:06 AM Pacific Daylight Time	08/05/2014 08:51:37 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	044	0	2015	Fresno County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5928	046	0	1	01	01	H5928_046_0	6		1	08/06/2014	2015.01	08/06/2014 09:44:57 AM Pacific Daylight Time	08/05/2014 07:34:46 AM Pacific Daylight Time	08/05/2014 08:52:04 AM Pacific Daylight Time			08/06/2014 04:22:28 PM Pacific Daylight Time	CARE1ST HEALTH PLAN	Care1st Health Plan	www.care1stmedicare.com	Care1st AdvantageOptimum Plan (HMO)	01	01		1			H5928	046	0	2015	Merced County		2		2			2							www.care1stmedicare.com	www.care1stmedicare.com	www.care1stmedicare.com	(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(800)544-0088		(800)544-0088		(800)847-1222		(800)847-1222		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5932	001	0	1	01	01	H5932_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:45:47 AM Eastern Daylight Time	08/04/2014 11:10:48 AM Eastern Daylight Time	07/31/2014 04:07:02 PM Eastern Daylight Time			08/06/2014 01:52:28 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H5932	001	0	2015	Pennsylvania Counties		2	48206	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5932	007	0	1	01	01	H5932_007_0	6		1	07/24/2014	2015.01	07/24/2014 12:22:01 PM Eastern Daylight Time	08/04/2014 10:25:28 AM Eastern Daylight Time	07/31/2014 04:07:11 PM Eastern Daylight Time			08/06/2014 01:54:34 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H5932	007	0	2015	Pennsylvania Counties		2	910	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5932	008	0	1	01	01	H5932_008_0	6		1	07/24/2014	2015.01	07/24/2014 12:22:07 PM Eastern Daylight Time	08/04/2014 10:25:46 AM Eastern Daylight Time	07/31/2014 04:07:19 PM Eastern Daylight Time			08/06/2014 01:56:37 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H5932	008	0	2015	Pennsylvania Counties		2	4956	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5932	009	0	1	01	01	H5932_009_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:46:31 AM Eastern Daylight Time	08/04/2014 10:26:04 AM Eastern Daylight Time	07/31/2014 04:07:29 PM Eastern Daylight Time			08/06/2014 01:58:48 PM Eastern Daylight Time	GATEWAY HEALTH PLAN, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H5932	009	0	2015	Pennsylvania Counties		2	2586	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(800)685-5209		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5934	001	0	1	20	08	H5934_001_0	2		1	05/20/2014	2015.01	05/20/2014 01:19:10 PM Eastern Daylight Time		05/19/2014 04:40:39 PM Eastern Daylight Time			05/20/2014 04:40:31 PM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	http://hopehcs.org/pace	Hope PACE (PACE)	08	20		1			H5934	001	0	2015	Lee, Charlotte and Collier Counties Florida		2		2			2								hopehcs.org/pace	carekinesis.com									(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400												
H5934	002	0	1	20	08	H5934_002_0	2		1	05/20/2014	2015.01	05/20/2014 01:19:42 PM Eastern Daylight Time		05/19/2014 04:40:39 PM Eastern Daylight Time			05/20/2014 04:40:31 PM Eastern Daylight Time	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	Hope PACE	http://hopehcs.org/pace	Hope PACE (PACE)	08	20		1			H5934	002	0	2015	Lee, Charlotte and Collier Counties Florida		2		2			2								hopehcs.org/pace	carekinesis.com									(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400										(866)659-7223		(239)985-6400		(866)659-7223		(239)985-6400												
H5938	001	0	1	01	01	H5938_001_0	9		1	08/11/2014	2015.01	08/11/2014 01:59:30 PM Eastern Daylight Time	08/09/2014 11:15:14 AM Eastern Daylight Time	08/06/2014 10:18:00 AM Eastern Daylight Time			08/12/2014 10:45:08 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Advantage Plus (HMO)	01	01		1			H5938	001	0	2015	Leon and surrounding counties		2	7020	2			2							www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		2					2					2
H5938	006	0	1	01	01	H5938_006_0	7		1	07/23/2014	2015.01	07/23/2014 11:17:33 AM Eastern Daylight Time	08/06/2014 10:15:47 AM Eastern Daylight Time	08/06/2014 10:21:07 AM Eastern Daylight Time			08/06/2014 10:38:03 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Preferred Advantage (HMO)	01	01		1			H5938	006	0	2015	Leon and surrounding counties		2	1982	2			2							www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		2					2					2
H5938	802	0	1	01	01	H5938_802_0	5		1	05/21/2014	2015.01	05/21/2014 02:42:15 PM Eastern Daylight Time	06/06/2014 09:47:36 AM Eastern Daylight Time				06/09/2014 04:14:42 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	802	0	2015	Leon and surrounding counties		1	6952	2			2							www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		1	1	011100011000100000000001001100000110	1	011111001001000100001101111	1					1
H5938	803	0	1	01	01	H5938_803_0	5		1	05/21/2014	2015.01	05/21/2014 02:42:29 PM Eastern Daylight Time	07/14/2014 08:50:40 AM Eastern Daylight Time				07/14/2014 11:39:00 AM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	803	0	2015	Leon and surrounding counties		1	838	2			2							www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441										(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534										1	1	011100011000100000000001001100000110	1	011111001001000100001101111	1					1
H5938	804	0	1	01	01	H5938_804_0	5		1	05/21/2014	2015.01	05/21/2014 02:42:40 PM Eastern Daylight Time	06/06/2014 09:47:36 AM Eastern Daylight Time				06/09/2014 04:14:42 PM Eastern Daylight Time	CAPITAL HEALTH PLAN	Capital Health Plan	www.capitalhealth.com/Medicare	Capital Health Plan Retiree Advantage (HMO)	01	01		1			H5938	804	0	2015	Leon and surrounding counties		1	1427	2			2							www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	www.capitalhealth.com/Medicare	(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)247-6512		(850)523-7441		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		(877)870-8943		(850)383-3534		1	1	011100011000100000000000001100000110	1	011111000001000100001101111	1					1
H5943	001	0	1	02	01	H5943_001_0	9		1	08/06/2014	2015.01	08/06/2014 02:50:47 PM Pacific Daylight Time		07/31/2014 02:11:16 PM Pacific Daylight Time		08/05/2014 02:46:47 PM Pacific Daylight Time	08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO-POS SNP)	01	02		1			H5943	001	0	2015	Riverside and  San Bernardino Counties		2		2			1	4		1		00000000100000000000		www.villagehealthca.com	www.villagehealthca.com	www.villagehealthca.com	(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5943	002	0	1	01	01	H5943_002_0	7		1	08/05/2014	2015.01	08/05/2014 10:20:46 AM Pacific Daylight Time		07/31/2014 01:59:58 PM Pacific Daylight Time		08/05/2014 06:42:10 PM Pacific Daylight Time	08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	VillageHealth	www.villagehealthca.com	VillageHealth (HMO SNP)	01	01		1			H5943	002	0	2015	Los Angeles and Orange Counties		2		2			1	4		1		00000000100000000000		www.villagehealthca.com	www.villagehealthca.com	www.villagehealthca.com	(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(800)399-7226		(800)399-7226		(877)916-1234		(877)916-1234		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5945	001	0	1	01	01	H5945_001_0	9		1	08/07/2014	2015.01	08/07/2014 01:35:25 PM Eastern Daylight Time	08/05/2014 06:51:40 PM Eastern Daylight Time	08/05/2014 06:53:40 PM Eastern Daylight Time			08/07/2014 06:20:29 PM Eastern Daylight Time	SAINT MARY'S HEALTH FIRST	Saint Mary's Health First	www.saintmaryshealthplans.com	Prominence Value (HMO)	01	01		1			H5945	001	0	2015	Northern Nevada		2	327	1	1		2								www.saintmaryshealthplans.com	http://www.saintmaryshealthplans.com/index.htm			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		2					1					2
H5945	002	0	1	01	01	H5945_002_0	8		1	08/07/2014	2015.01	08/07/2014 01:36:30 PM Eastern Daylight Time	08/05/2014 06:52:21 PM Eastern Daylight Time	08/06/2014 04:13:06 PM Eastern Daylight Time			08/07/2014 06:22:42 PM Eastern Daylight Time	SAINT MARY'S HEALTH FIRST	Saint Mary's Health First	www.saintmaryshealthplans.com	Prominence Plus (HMO)	01	01		1			H5945	002	0	2015	Washoe County		2	810	1	1		2								www.saintmaryshealthplans.com	http://www.saintmaryshealthplans.com/index.htm			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		2					1					2
H5945	801	0	1	01	01	H5945_801_0	4		1	05/29/2014	2015.01	05/29/2014 02:54:51 AM Eastern Daylight Time	07/16/2014 12:01:11 PM Eastern Daylight Time				07/22/2014 09:23:10 PM Eastern Daylight Time	SAINT MARY'S HEALTH FIRST	Saint Mary's Health First	http://www.saintmaryshealthplans.com/index.htm	Prominence Health Plan (HMO)	01	01		1			H5945	801	0	2015	National		1	1	1	1		2								http://www.saintmaryshealthplans.com/index.htm	http://www.saintmaryshealthplans.com/index.htm			(188)888-8888				(188)888-8888										(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888										1	2		2		1					1
H5945	802	0	1	01	01	H5945_802_0	6		1	05/29/2014	2015.01	05/29/2014 02:55:46 AM Eastern Daylight Time	07/16/2014 12:02:02 PM Eastern Daylight Time				07/22/2014 09:24:37 PM Eastern Daylight Time	SAINT MARY'S HEALTH FIRST	Saint Mary's Health First	http://www.saintmaryshealthplans.com/index.htm	Prominence Health Plan (HMO)	01	01		1			H5945	802	0	2015	National		1	1	1	1		2								http://www.saintmaryshealthplans.com/index.htm	http://www.saintmaryshealthplans.com/index.htm			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		1	2		2		1					1
H5945	803	0	1	01	01	H5945_803_0	6		1	05/29/2014	2015.01	05/29/2014 02:56:31 AM Eastern Daylight Time	07/16/2014 12:02:46 PM Eastern Daylight Time				07/22/2014 09:26:04 PM Eastern Daylight Time	SAINT MARY'S HEALTH FIRST	Saint Mary's Health First	http://www.saintmaryshealthplans.com/index.htm	Prominence Health Plan (HMO)	01	01		1			H5945	803	0	2015	National		1	1	1	1		2								http://www.saintmaryshealthplans.com/index.htm	http://www.saintmaryshealthplans.com/index.htm			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		1	2		2		1					1
H5969	002	0	1	01	01	H5969_002_0	9	2	1	08/12/2014	2015.01	08/12/2014 08:15:43 AM Hawaiian Standard Time	08/11/2014 12:21:12 PM Hawaiian Standard Time	08/01/2014 12:27:55 PM Hawaiian Standard Time			08/12/2014 08:27:59 AM Hawaiian Standard Time	ALOHACARE	AlohaCare	AlohaCare.org	AlohaCare Advantage Plus (HMO SNP)	01	01		1			H5969	002	0	2015	State of Hawaii		2	1100	2			1	3		1	3		1	AlohaCare.org	AlohaCare.org	http://www.AlohaCare.org/providersearch	(866)973-6395		(808)973-6395		(866)973-6395		(808)973-6395		(866)973-6395		(808)973-6395		(866)973-6395		(808)973-6395		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		(877)447-5990		2					2					2
H5970	001	0	1	04	01	H5970_001_0	3		1	07/10/2014	2015.02	07/10/2014 02:29:06 PM Eastern Daylight Time	08/04/2014 11:34:20 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-001 (PPO)	01	04		1			H5970	001	0	2015	Southern Tier Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5970	002	0	1	04	01	H5970_002_0	3		1	07/10/2014	2015.02	07/10/2014 02:34:57 PM Eastern Daylight Time	08/04/2014 11:45:47 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-002 (PPO)	01	04		1			H5970	002	0	2015	Central New York Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5970	004	0	1	04	01	H5970_004_0	3		1	07/10/2014	2015.02	07/10/2014 02:40:23 PM Eastern Daylight Time	08/04/2014 11:37:26 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-004 (PPO)	01	04		1			H5970	004	0	2015	Upstate Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5970	008	0	1	04	01	H5970_008_0	3		1	07/10/2014	2015.02	07/10/2014 05:16:44 PM Eastern Daylight Time	08/04/2014 11:46:17 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-008 (PPO)	01	04		1			H5970	008	0	2015	Capital District Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5970	010	0	1	04	01	H5970_010_0	3		1	07/10/2014	2015.02	07/10/2014 05:18:42 PM Eastern Daylight Time	08/04/2014 11:36:24 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-010 (PPO)	01	04		1			H5970	010	0	2015	Capital District Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5970	013	0	1	04	01	H5970_013_0	5		1	07/11/2014	2015.02	07/11/2014 09:37:27 AM Eastern Daylight Time	08/04/2014 11:59:19 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 09:24:41 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	HumanaChoice H5970-013 (PPO)	01	04		1			H5970	013	0	2015	New York County		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H5970	801	0	1	04	01	H5970_801_0	2		1	05/27/2014	2015.02	05/27/2014 02:45:16 PM Eastern Daylight Time	07/14/2014 09:49:54 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5970	801	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5970	802	0	1	04	01	H5970_802_0	2		1	05/27/2014	2015.02	05/27/2014 02:46:02 PM Eastern Daylight Time	07/14/2014 09:50:11 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H5970	802	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5970	803	0	1	04	01	H5970_803_0	2		1	05/28/2014	2015.02	05/28/2014 03:08:45 PM Eastern Daylight Time	07/14/2014 09:50:27 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H5970	803	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5970	805	0	2	04	01	H5970_805_0	2		1	05/28/2014	2015.02	05/28/2014 03:08:35 PM Eastern Daylight Time	07/14/2014 09:51:33 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5970	805	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5970	806	0	2	04	01	H5970_806_0	2		1	05/28/2014	2015.02	05/28/2014 03:09:14 PM Eastern Daylight Time	07/14/2014 09:51:50 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H5970	806	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5970	807	0	2	04	01	H5970_807_0	2		1	05/28/2014	2015.02	05/28/2014 03:09:53 PM Eastern Daylight Time	07/14/2014 09:52:05 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H5970	807	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5970	814	0	1	04	01	H5970_814_0	3		1	05/27/2014	2015.02	05/27/2014 01:27:22 PM Eastern Daylight Time	07/14/2014 09:54:15 AM Eastern Daylight Time				07/14/2014 01:11:29 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer - Walmart (PPO)	01	04		1			H5970	814	0	2015	State of New York		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H5978	001	0	1	20	08	H5978_001_0	1		1	05/27/2014	2015.01	05/27/2014 09:16:51 AM Eastern Daylight Time		05/22/2014 08:48:40 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	PHI LIFE dba everyday LIFE	www.seniorlifepa.com	Senior LIFE Lehigh Valley Dual Eligible (PACE)	08	20		1			H5978	001	0	2015	Senior LIFE Northampton Lehigh County Dual		2	135	2			2								NA	www.granepharmacy.com									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H5978	002	0	1	20	08	H5978_002_0	1		1	05/27/2014	2015.01	05/27/2014 09:17:30 AM Eastern Daylight Time		05/22/2014 08:48:40 AM Eastern Daylight Time			05/27/2014 02:17:44 PM Eastern Daylight Time	SENIOR LIFE LEHIGH VALLEY, INC.	PHI LIFE dba everyday LIFE	www.everydaylifecenters.org	Senior LIFE Lehigh Valley MC Only (PACE)	08	20		1			H5978	002	0	2015	Senior LIFE Lehigh and Northampton County MC Only		2	4	2			2								NA	www.granepharmacy.com									(877)998-5433	102	(814)535-6000	102	(877)998-5433	102	(814)535-6000	102									(877)998-5433		(814)535-6000		(877)998-5433		(814)535-6000												
H5985	001	0	1	01	01	H5985_001_0	5		1	08/05/2014	2015.01	08/05/2014 09:04:24 AM US Mountain Standard Time	08/06/2014 08:54:12 AM US Mountain Standard Time	08/06/2014 08:54:11 AM US Mountain Standard Time			08/06/2014 09:20:22 AM US Mountain Standard Time	PHOENIX HEALTH PLANS, INC.	Phoenix Health Plans	www.phoenixhealthplans.com	Phoenix Advantage (HMO)	01	01		1			H5985	001	0	2015	Arizona		2	3000	2			2							http://www.phoenixhealthplans.com/find_a_doctor.aspx	www.phoenixhealthplans.com	www.phoenixhealthplans.com	(888)864-1114		(602)824-3900		(844)298-7800		(602)824-3900		(888)864-1114		(602)824-3900		(844)298-7800		(602)824-3900		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		2					2					2
H5985	002	0	1	01	01	H5985_002_0	9	2	1	08/05/2014	2015.01	08/05/2014 09:05:39 AM US Mountain Standard Time	08/06/2014 08:54:11 AM US Mountain Standard Time	08/06/2014 08:54:11 AM US Mountain Standard Time			08/06/2014 09:23:53 AM US Mountain Standard Time	PHOENIX HEALTH PLANS, INC.	Phoenix Health Plans	www.phoenixhealthplans.com	Phoenix Advantage Plus (HMO SNP)	01	01		1			H5985	002	0	2015	Maricopa County		2	1300	2			1	3		1	4			http://www.phoenixhealthplans.com/find_a_doctor.aspx	www.phoenixhealthplans.com	www.phoenixhealthplans.com	(888)864-1114		(602)824-3900		(844)298-7800		(602)824-3900		(888)864-1114		(602)824-3900		(844)298-7800		(602)824-3900		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		2					2					2
H5985	005	0	1	01	01	H5985_005_0	5		1	08/05/2014	2015.01	08/05/2014 03:51:18 PM US Mountain Standard Time	08/06/2014 08:54:12 AM US Mountain Standard Time	08/06/2014 08:54:11 AM US Mountain Standard Time			08/06/2014 09:26:12 AM US Mountain Standard Time	PHOENIX HEALTH PLANS, INC.	Phoenix Health Plans	www.phoenixhealthplans.com	Phoenix Advantage Select (HMO)	01	01		1			H5985	005	0	2015	Arizona		2	900	2			2							http://www.phoenixhealthplans.com/find_a_doctor.aspx	www.phoenixhealthplans.com	www.phoenixhealthplans.com	(888)864-1114		(602)824-3900		(844)298-7800		(602)824-3900		(888)864-1114		(602)824-3900		(844)298-7800		(602)824-3900		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		(800)489-1472		(602)824-3909		2					2					2
H5989	002	0	1	01	01	H5989_002_0	6		1	08/05/2014	2015.02	08/05/2014 08:09:59 AM Central Daylight Time	08/05/2014 06:11:26 PM Central Daylight Time	08/04/2014 03:33:12 PM Central Daylight Time			08/06/2014 01:59:00 PM Central Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare, Inc.	www.centerlighthealthcare.org	CenterLight Healthcare Direct Complete Plan (HMO SNP)	01	01		1			H5989	002	0	2015	New York City Metro Area and Westchester County		2	1283	2			1	1	3	1				www.centerlighthealthcare.org	http://www.centerlighthealthcare.org	http://www.centerlighthealthcare.org	(877)226-8500		(347)640-6280		(877)226-8500		(347)640-6280		(800)935-7195		(800)935-7195		(877)226-8500		(347)640-6280		(711)-		(711)-		(711)-		(711)-		(800)759-1089		(800)759-1089		(711)-		(711)-		2					2					2
H5991	001	0	1	01	01	H5991_001_0	11	2	1	08/05/2014	2015.01	08/05/2014 12:02:17 PM Eastern Daylight Time	08/05/2014 09:50:24 AM Eastern Daylight Time	08/04/2014 04:09:14 PM Eastern Daylight Time			08/05/2014 12:27:09 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Ultimate (HMO SNP)	01	01		1			H5991	001	0	2015	NYC, Long Island, Westchester, Rockland, Orange		2	6800	2			1	3		1	3		1	www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2
H5991	002	0	1	01	01	H5991_002_0	11	2	1	08/05/2014	2015.01	08/05/2014 11:54:49 AM Eastern Daylight Time	08/05/2014 10:04:22 AM Eastern Daylight Time	08/04/2014 04:10:16 PM Eastern Daylight Time			08/05/2014 12:27:09 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Solutions (HMO SNP)	01	01		1			H5991	002	0	2015	NYC, Long Island, Westchester, Rockland, Orange		2	1800	2			1	3		1	2			www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2
H5991	003	0	1	01	01	H5991_003_0	8		1	08/05/2014	2015.01	08/05/2014 11:54:34 AM Eastern Daylight Time	08/05/2014 10:26:04 AM Eastern Daylight Time	08/04/2014 04:11:08 PM Eastern Daylight Time			08/05/2014 12:27:09 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Essentials (HMO)	01	01		1			H5991	003	0	2015	Counties:NY,RO,WE,NA,SU,OR		2	500	2			2							www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2
H5991	004	0	1	01	01	H5991_004_0	8		1	08/05/2014	2015.01	08/05/2014 11:55:05 AM Eastern Daylight Time	08/04/2014 04:07:30 PM Eastern Daylight Time	08/04/2014 04:11:34 PM Eastern Daylight Time			08/05/2014 12:27:09 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Select (HMO)	01	01		1			H5991	004	0	2015	Counties:NY, WE, NA, RO,OR,SU		2	700	2			2							www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2
H5991	005	0	1	01	01	H5991_005_0	10		1	08/05/2014	2015.01	08/05/2014 11:55:12 AM Eastern Daylight Time	08/04/2014 04:08:14 PM Eastern Daylight Time	08/04/2014 04:11:58 PM Eastern Daylight Time			08/05/2014 12:27:09 PM Eastern Daylight Time	AFFINITY HEALTH PLAN, INC.	Affinity Health Plan	www.affinitymedicareplan.org	Affinity Medicare Passport Elite (HMO)	01	01		1			H5991	005	0	2015	Counties:NY,WE,OR,NA,RO,SU		2	800	2			2							www.affinitymedicareplan.org	www.affinitymedicareplan.org	www.affinitymedicareplan.org	(877)234-4499		(877)234-4499		(877)234-4499		(877)234-4499		(866)362-4002		(866)236-1069		(877)234-4499		(877)234-4499		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)236-1069		(866)362-4002		(800)662-1220		(800)662-1220		2					2					2
H5992	007	0	1	01	01	H5992_007_0	13	2	1	08/11/2014	2015.01	08/11/2014 10:21:58 PM Eastern Daylight Time	08/06/2014 11:10:03 AM Eastern Daylight Time	08/06/2014 11:10:08 AM Eastern Daylight Time			08/12/2014 09:35:36 AM Eastern Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.seniorwholehealth.com	Senior Whole Health of New York NHC (HMO SNP)	01	01		1			H5992	007	0	2015	Bronx, Kings, Queens, and New York counties		2	132	2			1	3		1	5			www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(877)353-0185		(877)353-0185		(877)353-0188		(877)353-0188		(877)353-0185		(877)353-0185		(877)353-0188		(877)353-0188		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H5995	001	0	1	01	01	H5995_001_0	5	2	1	07/25/2014	2015.01	07/25/2014 11:35:46 AM Pacific Daylight Time	08/06/2014 01:11:13 PM Pacific Daylight Time	08/06/2014 01:11:18 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Special Needs Plan (Willamette) (HMO SNP)	01	01		1			H5995	001	0	2015	Marion and Polk Counties In Oregon		2	3250	2			1	3		1	3		2	www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					2
H6059	001	0	1	20	08	H6059_001_0	1		1	05/20/2014	2015.01	05/20/2014 01:26:57 PM Eastern Daylight Time		05/20/2014 01:26:02 PM Eastern Daylight Time			05/20/2014 01:40:28 PM Eastern Daylight Time	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Dual (PACE)	08	20		1			H6059	001	0	2015	PACE of The Triad - Dual		2		2			2								www.pacetriad.org	www.pacetriad.org									(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(336)621-2478		(336)621-2478		(336)621-2478		(336)621-2478												
H6059	002	0	1	20	08	H6059_002_0	1		1	05/20/2014	2015.01	05/20/2014 01:27:09 PM Eastern Daylight Time		05/20/2014 01:26:15 PM Eastern Daylight Time			05/20/2014 01:40:28 PM Eastern Daylight Time	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	PACE OF THE TRIAD	www.pacetriad.org	PACE of The Triad - Medicare only (PACE)	08	20		1			H6059	002	0	2015	PACE of The Triad - Medicare only		2		2			2								www.pacetriad.org	www.pacetriad.org									(336)550-4040		(336)550-4040		(336)550-4040		(336)550-4040										(336)621-2478		(336)621-2478		(336)621-2478		(336)621-2478												
H6079	001	0	1	20	08	H6079_001_0	1		1	05/28/2014	2015.01	05/28/2014 10:34:53 AM Mountain Daylight Time		05/28/2014 07:49:42 AM Mountain Daylight Time			05/28/2014 10:35:59 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge Greater California PACE	www.myinnovage.org	InnovAge Greater California PACE (PACE)	08	20		1			H6079	001	0	2015	San Bernardino and Riverside counties		2		2			2								www.myinnovage.org	www.pharmerica.com									(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664										(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664												
H6079	002	0	1	20	08	H6079_002_0	1		1	05/28/2014	2015.01	05/28/2014 10:35:11 AM Mountain Daylight Time		05/28/2014 07:55:44 AM Mountain Daylight Time			05/28/2014 10:35:59 AM Mountain Daylight Time	TOTAL LONGTERM CARE, INC.	InnovAge Greater California PACE	www.myinnovage.org	InnovAge Greater California PACE (PACE)	08	20		1			H6079	002	0	2015	San Bernardino and Riverside counties		2		2			2								www.myinnovage.org	www.pharmerica.com									(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664										(877)277-6163		(303)869-4664		(877)277-6163		(303)869-4664												
H6080	001	0	1	48	05	H6080_001_0	3		1	08/05/2014	2015.01	08/05/2014 02:54:54 PM Central Daylight Time					08/05/2014 11:00:35 PM Central Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Meridian Complete	www.MedicareMeridian.com	Meridian Complete (Medicare-Medicaid Plan)	05	48		1			H6080	001	0	2015	Cook, DuPage, Kane, and Will Counties		2	10000	2			2							www.MedicareMeridian.com	www.MedicareMeridian.com	www.MedicareMeridian.com	(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(855)580-1689		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6181	007	0	1	01	01	H6181_007_0	8	2	1	08/06/2014	2015.01	08/06/2014 11:59:43 AM Eastern Daylight Time	08/06/2014 02:49:34 PM Eastern Daylight Time	08/06/2014 04:06:23 PM Eastern Daylight Time			08/06/2014 04:32:52 PM Eastern Daylight Time	AMERIGROUP NEW YORK, LLC	HealthPlus Amerigroup	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H6181	007	0	2015	New York City Area		2	6948	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H6181	009	0	1	01	01	H6181_009_0	10		1	08/04/2014	2015.01	08/04/2014 12:43:48 PM Eastern Daylight Time	08/06/2014 02:27:09 PM Eastern Daylight Time	08/06/2014 04:06:27 PM Eastern Daylight Time			08/06/2014 04:32:52 PM Eastern Daylight Time	AMERIGROUP NEW YORK, LLC	HealthPlus Amerigroup	www.myamerigroup.com/medicare	Amerivantage Balance + Rx (HMO)	01	01		1			H6181	009	0	2015	New York City Area		2	5971	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H6229	005	0	1	48	05	H6229_005_0	8		1	07/24/2014	2015.01	07/24/2014 02:19:15 PM Eastern Daylight Time					07/25/2014 04:33:32 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	duals.caremore.com	CareMore Cal MediConnect Medicare-Medicaid Plan (Medicare-Medicaid Plan)	05	48		1			H6229	005	0	2015	Los Angeles County (Partial)		2	14000	2			2							duals.caremore.com	duals.caremore.com	duals.caremore.com	(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(888)350-3447		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6229	006	0	1	48	05	H6229_006_0	8		1	07/24/2014	2015.01	07/24/2014 02:19:33 PM Eastern Daylight Time					07/25/2014 04:33:32 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	Duals.anthem.com/ca	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H6229	006	0	2015	Santa Clara County		2	4700	2			2							Duals.anthem.com/ca	Duals.anthem.com/ca	Duals.anthem.com/ca	(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H6229	007	0	1	48	05	H6229_007_0	8		1	07/24/2014	2015.01	07/24/2014 02:19:48 PM Eastern Daylight Time					07/25/2014 04:33:32 PM Eastern Daylight Time	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN, INC.	Anthem Blue Cross Cal MediConnect	Duals.anthem.com/ca	Anthem Blue Cross Cal MediConnect (Medicare-Medicaid Plan)	05	48		1			H6229	007	0	2015	Alameda County		2	3300	2			2							Duals.anthem.com/ca	Duals.anthem.com/ca	Duals.anthem.com/ca	(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(855)817-5785		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H6231	001	0	1	20	08	H6231_001_0	1		1	05/28/2014	2015.01	05/28/2014 10:30:38 AM Central Daylight Time		05/28/2014 09:06:27 AM Central Daylight Time			05/28/2014 10:34:12 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	001	0	2015	PACE Baton Rouge		2		2			2								www.ololrmc.com	www.ololrmc.com									(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604												
H6231	002	0	1	20	08	H6231_002_0	1		1	05/28/2014	2015.01	05/28/2014 10:32:12 AM Central Daylight Time		05/28/2014 09:11:26 AM Central Daylight Time			05/28/2014 10:34:12 AM Central Daylight Time	FRANCISCAN PACE, INC.	PACE Baton Rouge	www.fmolhs.org	Franciscan PACE, Inc. (PACE)	08	20		1			H6231	002	0	2015	PACE Baton Rouge		2		2			2								www.ololrmc.com	www.ololrmc.com									(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604										(800)789-2863		(225)490-0604		(800)789-2863		(225)490-0604												
H6237	003	1	1	01	01	H6237_003_1	9		1	08/04/2014	2015.01	08/04/2014 10:18:28 PM Mountain Daylight Time	08/05/2014 10:08:28 AM Pacific Daylight Time	08/01/2014 08:31:36 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	003	1	2015	Portland Metro Area and Clark County, WA	Multnomah & Washington Counties	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6237	003	2	1	01	01	H6237_003_2	9		1	08/04/2014	2015.01	08/04/2014 10:19:44 PM Mountain Daylight Time	08/05/2014 10:08:06 AM Pacific Daylight Time	08/01/2014 08:32:04 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF OREGON	Regence BlueCross BlueShield of Oregon	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H6237	003	2	2015	Portland Metro Area and Clark County, WA	Clackamas, Marion, Polk & Clark (WA) Counties	2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6263	001	0	1	48	05	H6263_001_0	5		1	08/29/2014	2015.01	08/29/2014 04:01:35 PM Eastern Daylight Time					08/29/2014 04:07:31 PM Eastern Daylight Time	HEALTH INSURANCE PLAN OF GREATER NEW YORK	EmblemHealth FIDA	http://emblemhealth.com/fida	EmblemHealth Dual Assurance FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6263	001	0	2015	Counties: BRX, KI, NA, NY, QU, RI, SUF, WES		2		2			2								emblemhealth.com	emblemhealth.com	(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(877)344-7364		(877)344-7364		(800)447-9169		(800)447-9169		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6298	001	0	1	01	01	H6298_001_0	7		1	08/05/2014	2015.01	08/05/2014 09:49:45 AM Eastern Daylight Time	08/05/2014 04:31:40 AM Eastern Daylight Time	07/31/2014 12:32:44 PM Eastern Daylight Time			08/05/2014 10:12:12 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan Integrated Care	healthspan.org/medicare	HealthSpan Medicare Standard (HMO)	01	01		1			H6298	001	0	2015	Ohio		2	3264	2			2							healthspan.org/medicare	http://www.healthspan.org/seniormedrx#2014	http://www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6298	002	0	1	01	01	H6298_002_0	10		1	08/14/2014	2015.01	08/14/2014 03:30:46 PM Eastern Daylight Time	08/06/2014 07:13:48 AM Eastern Daylight Time	07/31/2014 12:33:36 PM Eastern Daylight Time			08/14/2014 03:50:56 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan Integrated Care	healthspan.org/medicare	HealthSpan Medicare Enhanced (HMO)	01	01		1			H6298	002	0	2015	Ohio		2	4140	2			2							healthspan.org/medicare	http://www.healthspan.org/seniormedrx#2014	http://www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6298	003	0	1	01	01	H6298_003_0	8		1	09/22/2014	2015.01	09/22/2014 09:44:53 AM Eastern Daylight Time	08/05/2014 04:53:26 AM Eastern Daylight Time	07/31/2014 12:34:36 PM Eastern Daylight Time			09/22/2014 09:53:10 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan Integrated Care	healthspan.org/medicare	HealthSpan Medicare Basic (HMO)	01	01		1			H6298	003	0	2015	Ohio		2	239	2			2							healthspan.org/medicare	http://www.healthspan.org/seniormedrx#2014	http://www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6298	004	0	1	01	01	H6298_004_0	12		1	08/14/2014	2015.01	08/14/2014 03:32:02 PM Eastern Daylight Time	08/06/2014 07:12:00 AM Eastern Daylight Time	07/31/2014 12:35:18 PM Eastern Daylight Time			08/14/2014 04:02:24 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan Integrated Care	healthspan.org/medicare	HealthSpan Medicare Premier (HMO)	01	01		1			H6298	004	0	2015	Ohio		2	318	2			2							healthspan.org/medicare	http://www.healthspan.org/seniormedrx#2014	http://www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6298	005	0	1	01	01	H6298_005_0	6		1	06/23/2014	2015.01	06/23/2014 12:19:05 PM Eastern Daylight Time	08/11/2014 01:18:37 PM Eastern Daylight Time				08/11/2014 02:20:48 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan Integrated Care	healthspan.org/medicare	HealthSpan Medicare Core 1 (HMO)	01	01		1			H6298	005	0	2015	Ohio		2	1802	2			2							healthspan.org/medicare	http://www.healthspan.org/seniormedrx#2014	http://www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										1	2		2		1					2
H6298	007	0	1	01	01	H6298_007_0	9		1	07/08/2014	2015.01	07/08/2014 01:32:47 PM Eastern Daylight Time	08/05/2014 04:37:04 AM Eastern Daylight Time	07/31/2014 12:36:42 PM Eastern Daylight Time			08/05/2014 10:54:16 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan Integrated Care	healthspan.org/medicare	HealthSpan Medicare Core 2 (HMO)	01	01		1			H6298	007	0	2015	Ohio		2	4200	2			2							healthspan.org/medicare	http://www.healthspan.org/seniormedrx#2014	http://www.healthspan.org/seniormedrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					2
H6306	002	0	1	01	01	H6306_002_0	4		1	08/05/2014	2015.01	08/05/2014 04:10:32 PM Pacific Daylight Time	08/06/2014 09:21:21 AM Pacific Daylight Time	08/06/2014 09:21:19 AM Pacific Daylight Time			08/06/2014 09:30:10 AM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstCarolinaCare Insurance Company	www.firstmedicare.com	FirstMedicare Direct HMO Plus (HMO)	01	01		1			H6306	002	0	2015	South Central North Carolina		2	4513	2			2							www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6308	001	0	1	48	05	H6308_001_0	7		1	08/29/2014	2015.01	08/29/2014 11:01:44 AM Eastern Daylight Time					08/29/2014 11:03:12 AM Eastern Daylight Time	AGEWELL NEW YORK, LLC	AgeWell New York	www.agewellnewyork.com	AgeWell New York FIDA (Medicare-Medicaid Plan)	05	48		1			H6308	001	0	2015	Ki, Qu, Brx, NY, Wes, Suf, NA		2		2			2							www.agewellnewyork.com	www.agewellnewyork.com	www.agewellnewyork.com	(866)586-8044		(866)586-8044		(866)586-8044		(866)586-8044		(855)889-0046		(855)889-0046		(866)586-8044		(866)586-8044		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(711)-		(711)-		(800)662-1220		(800)662-1220		2					2					2
H6310	001	0	1	20	08	H6310_001_0	1		1	05/20/2014	2015.01	05/20/2014 08:35:51 AM Eastern Daylight Time		05/17/2014 01:43:04 PM Eastern Daylight Time			05/20/2014 08:38:24 AM Eastern Daylight Time	INOVACARES	InovaCares for Seniors	www.Inova.org	InovaCares for Seniors Dual Eligible (PACE)	08	20		1			H6310	001	0	2015	Northern Virginia		2		2			2								www.inova.org	www.omnicare.com									(877)409-2811		(866)288-4938		(877)409-2811		(866)288-4938										(888)206-8041		(888)206-8041		(888)206-8041		(888)206-8041												
H6310	002	0	1	20	08	H6310_002_0	1		1	05/20/2014	2015.01	05/20/2014 08:36:41 AM Eastern Daylight Time		05/17/2014 01:51:48 PM Eastern Daylight Time			05/20/2014 08:38:24 AM Eastern Daylight Time	INOVACARES	InovaCares for Seniors	www.Inova.org	InovaCares for Seniors Medicare Only (PACE)	08	20		1			H6310	002	0	2015	Northern Virginia		2		2			2								www.inova.org	www.omnicare.com									(877)409-2811		(866)288-4938		(877)409-2811		(866)288-4938										(888)206-8041		(888)206-8041		(888)206-8041		(888)206-8041												
H6328	001	0	1	04	01	H6328_001_0	10		1	08/11/2014	2015.01	08/11/2014 04:45:53 PM Eastern Daylight Time	08/04/2014 08:09:43 PM Eastern Daylight Time	07/31/2014 04:25:43 PM Eastern Daylight Time			08/11/2014 04:47:39 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan I (PPO)	01	04		1			H6328	001	0	2015	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6328	002	0	1	04	01	H6328_002_0	9		1	08/05/2014	2015.01	08/05/2014 04:59:35 AM Eastern Daylight Time	08/04/2014 08:13:04 PM Eastern Daylight Time	07/31/2014 04:27:54 PM Eastern Daylight Time			08/05/2014 05:03:40 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan II (PPO)	01	04		1			H6328	002	0	2015	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6328	003	0	1	04	01	H6328_003_0	9		1	08/05/2014	2015.01	08/05/2014 05:00:43 AM Eastern Daylight Time	08/04/2014 08:18:13 PM Eastern Daylight Time	07/31/2014 04:29:54 PM Eastern Daylight Time			08/05/2014 05:03:40 AM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan III (PPO)	01	04		1			H6328	003	0	2015	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6328	005	0	1	04	01	H6328_005_0	7		1	07/24/2014	2015.01	07/24/2014 04:10:30 PM Eastern Daylight Time	07/15/2014 07:22:56 PM Eastern Daylight Time				07/24/2014 04:31:25 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan I MA-Only (PPO)	01	04		1			H6328	005	0	2015	Dallas/Fort Worth Metro Area		2	500	2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										2					2					
H6328	801	0	1	04	01	H6328_801_0	4		1	07/17/2014	2015.01	07/17/2014 08:53:27 PM Eastern Daylight Time	07/15/2014 06:39:30 PM Eastern Daylight Time				07/17/2014 08:55:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group CY (PPO)	01	04		1			H6328	801	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H6328	802	0	1	04	01	H6328_802_0	4		1	05/30/2014	2015.01	05/30/2014 12:03:57 PM Eastern Daylight Time	07/15/2014 06:50:48 PM Eastern Daylight Time				07/17/2014 08:55:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group NCY (PPO)	01	04		1			H6328	802	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622		(855)791-5302		(855)791-5302		(877)665-2622		(877)665-2622		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
H6328	803	0	1	04	01	H6328_803_0	4		1	05/30/2014	2015.01	05/30/2014 12:04:02 PM Eastern Daylight Time	07/15/2014 06:54:20 PM Eastern Daylight Time				07/17/2014 08:55:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group CY (PPO)	01	04		1			H6328	803	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H6328	804	0	1	04	01	H6328_804_0	4		1	05/30/2014	2015.01	05/30/2014 12:04:06 PM Eastern Daylight Time	07/15/2014 06:59:32 PM Eastern Daylight Time				07/17/2014 08:55:03 PM Eastern Daylight Time	CARE N' CARE INSURANCE COMPANY, INC.	Care N Care Insurance Company	www.cnchealthplan.com	Care N' Care Health Plan Employer Group NCY (PPO)	01	04		1			H6328	804	0	2015	Nationwide		1		2			2							www.cnchealthplan.com	www.cnchealthplan.com	www.cnchealthplan.com	(877)374-7993		(877)374-7993		(877)665-2622		(877)665-2622										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
H6360	001	0	1	18	06	H6360_001_0	6		1	09/22/2014	2015.01	09/22/2014 09:28:48 AM Eastern Daylight Time		07/31/2014 12:38:34 PM Eastern Daylight Time			09/22/2014 10:12:01 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus I (Cost)	06	18		1			H6360	001	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	3200	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6360	002	0	1	18	06	H6360_002_0	5		1	07/23/2014	2015.01	07/23/2014 09:39:49 AM Eastern Daylight Time		07/31/2014 12:39:34 PM Eastern Daylight Time			08/05/2014 11:13:13 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus II (Cost)	06	18		1			H6360	002	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	1660	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6360	004	0	1	18	06	H6360_004_0	3		1	07/09/2014	2015.01	07/09/2014 12:39:02 PM Eastern Daylight Time					07/14/2014 05:45:43 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus Basic I (Cost)	06	18		1			H6360	004	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	10	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										2					2					2
H6360	006	0	1	18	06	H6360_006_0	5		1	07/22/2014	2015.01	07/22/2014 05:12:18 PM Eastern Daylight Time		07/31/2014 12:40:54 PM Eastern Daylight Time			08/05/2014 11:25:02 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus III (Cost)	06	18		1			H6360	006	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	296	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6360	007	0	1	18	06	H6360_007_0	2		1	07/09/2014	2015.01	07/09/2014 12:45:05 PM Eastern Daylight Time					07/14/2014 06:07:52 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus Basic II (Cost)	06	18		1			H6360	007	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	35	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										2					2					2
H6360	008	0	1	18	06	H6360_008_0	2		1	07/09/2014	2015.01	07/09/2014 12:47:55 PM Eastern Daylight Time					07/14/2014 06:07:52 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus Basic III (Cost)	06	18		1			H6360	008	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	117	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										2					2					2
H6360	009	0	2	18	06	H6360_009_0	4		1	07/15/2014	2015.01	07/15/2014 03:58:04 PM Eastern Daylight Time		07/31/2014 12:43:16 PM Eastern Daylight Time			08/05/2014 11:33:57 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus I - B only (Cost)	06	18		2	1		H6360	009	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	1	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6360	010	0	1	18	06	H6360_010_0	5		1	08/05/2014	2015.01	08/05/2014 11:42:33 AM Eastern Daylight Time		07/31/2014 12:44:08 PM Eastern Daylight Time			08/05/2014 11:54:31 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus IV (Cost)	06	18		1			H6360	010	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	592	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6360	011	0	1	18	06	H6360_011_0	2		1	07/09/2014	2015.01	07/09/2014 12:57:23 PM Eastern Daylight Time					07/14/2014 07:36:42 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus Basic IV (Cost)	06	18		1			H6360	011	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	18	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										2					2					2
H6360	012	0	1	18	06	H6360_012_0	4		1	07/15/2014	2015.01	07/15/2014 10:53:42 AM Eastern Daylight Time					07/15/2014 03:05:17 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Only Basic (Cost)	06	18		1			H6360	012	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	0	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										2					2					2
H6360	013	0	2	18	06	H6360_013_0	3		1	07/15/2014	2015.01	07/15/2014 03:10:47 PM Eastern Daylight Time					07/15/2014 03:16:58 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Only Basic - B Only (Cost)	06	18		2	1		H6360	013	0	2015	Counties: Cuy, Gea, Lak, Lor, Med, Por, Sum		2	0	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495										(711)-		(711)-		(711)-		(711)-										2					2					2
H6360	801	0	1	18	06	H6360_801_0	1		1	05/30/2014	2015.01	05/30/2014 10:29:32 AM Eastern Daylight Time					05/30/2014 12:16:13 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus Group (Cost)	06	18		1			H6360	801	0	2015	Ohio		1	518	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H6360	805	0	2	18	06	H6360_805_0	1		1	05/30/2014	2015.01	05/30/2014 10:29:49 AM Eastern Daylight Time					05/30/2014 12:13:29 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	HealthSpan Medicare Plus Group - B only (Cost)	06	18		2	1		H6360	805	0	2015	Ohio		1	172	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H6360	806	0	1	18	06	H6360_806_0	2		1	05/30/2014	2015.01	05/30/2014 10:30:01 AM Eastern Daylight Time					05/30/2014 12:10:26 PM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	FEHB AB with D (Cost)	06	18		1			H6360	806	0	2015	Ohio		1	600	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H6360	807	0	2	18	06	H6360_807_0	2		1	05/30/2014	2015.01	05/30/2014 10:30:13 AM Eastern Daylight Time					05/30/2014 11:50:54 AM Eastern Daylight Time	HEALTHSPAN INTEGRATED CARE	HealthSpan	kp.org/medicare	FEHB B only with D (Cost)	06	18		2	1		H6360	807	0	2015	Ohio		1	0	2			2								www.kp.org/seniorrx	www.kp.org/seniorrx	(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(800)493-6004		(216)621-7100		(877)408-3495		(877)408-3495		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-												
H6371	001	0	1	20	08	H6371_001_0	1		1	05/21/2014	2015.01	05/21/2014 01:10:50 PM Eastern Daylight Time		05/20/2014 07:01:21 PM Eastern Daylight Time			05/21/2014 01:11:59 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	001	0	2015	Lutheran Senior LIFE Hudson County		2		2			2								www.lifelsmnj.org	www.lifelsmnj.org									(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091												
H6371	002	0	1	20	08	H6371_002_0	1		1	05/20/2014	2015.01	05/20/2014 01:14:48 PM Eastern Daylight Time		05/20/2014 07:08:40 PM Eastern Daylight Time			05/21/2014 01:11:59 PM Eastern Daylight Time	LUTHERAN SENIOR HEALTHCARE, INC.	Lutheran Senior LIFE	www.lsmnj.org	Lutheran Senior Healthcare (PACE)	08	20		1			H6371	002	0	2015	Lutheran Senior LIFE Hudson County		2		2			2								www.lifelsmnj.org	www.lifelsmnj.org									(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091										(877)543-3188		(201)706-2091		(877)543-3188		(201)706-2091												
H6435	001	0	1	48	05	H6435_001_0	4		1	07/24/2014	2015.01	07/24/2014 02:51:41 PM Eastern Daylight Time					07/24/2014 02:53:09 PM Eastern Daylight Time	ELDERSERVE HEALTH, INC.	ElderServe Star FIDA Plan	www.elderservehealth.org	ElderServe Star FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6435	001	0	2015	Brx, Ki, Na, NY, Qu, Ri, Suf, Wes		2	250	2			2							www.elderservehealth.org	www.elderservehealth.org	www.meridianrx.com			(800)370-3600				(800)370-3600		(855)580-1693		(313)324-3800		(855)580-1693		(313)324-3800		(866)236-5800		(866)236-5800		(866)236-5800		(866)236-5800		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H6528	006	0	1	04	01	H6528_006_0	4		1	07/16/2014	2015.02	07/16/2014 03:32:22 PM Central Daylight Time	08/04/2014 02:56:53 PM Central Daylight Time	07/31/2014 03:27:21 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H6528	006	0	2015	Various Counties in AR, GA, MO, and SC		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6528	016	0	1	04	01	H6528_016_0	4		1	07/16/2014	2015.02	07/16/2014 02:11:21 PM Central Daylight Time	08/04/2014 04:22:16 PM Central Daylight Time	07/31/2014 03:27:24 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H6528	016	0	2015	Various Counties in AR, GA, MO, and SC		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6528	029	0	1	04	01	H6528_029_0	4		1	07/16/2014	2015.02	07/16/2014 02:11:00 PM Central Daylight Time	08/04/2014 04:22:31 PM Central Daylight Time	07/31/2014 03:27:27 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (PPO SNP)	01	04		1			H6528	029	0	2015	Various Counties in Illinois, Indiana		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6528	030	0	1	04	01	H6528_030_0	4		1	07/16/2014	2015.02	07/16/2014 03:30:38 PM Central Daylight Time	08/04/2014 02:57:09 PM Central Daylight Time	07/31/2014 03:27:30 PM Central Daylight Time			08/06/2014 10:38:12 AM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (PPO)	01	04		1			H6528	030	0	2015	Various Counties in Illinois, Indiana		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6551	001	0	1	20	08	H6551_001_0	3		1	06/02/2014	2015.01	06/02/2014 09:02:03 AM Eastern Daylight Time		06/01/2014 08:47:16 PM Eastern Daylight Time			06/02/2014 09:03:19 AM Eastern Daylight Time	LIFE ST. MARY, INC.	LIFE St. Mary	http://www.lifestmary.org/	LIFE St. Mary (PACE)	08	20		1			H6551	001	0	2015	LIFE St. Mary		2		2			2								stmaryhealthcare.org	stmaryhealthcare.org									(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601												
H6551	002	0	1	20	08	H6551_002_0	3		1	06/02/2014	2015.01	06/02/2014 09:02:26 AM Eastern Daylight Time		06/01/2014 09:02:00 PM Eastern Daylight Time			06/02/2014 09:03:19 AM Eastern Daylight Time	LIFE ST. MARY, INC.	LIFE St. Mary	http://www.lifestmary.org/	LIFE St. Mary (PACE)	08	20		1			H6551	002	0	2015	LIFE St. Mary		2		2			2								stmaryhealthcare.org	stmaryhealthcare.org									(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601										(267)991-7601		(267)991-7601		(267)991-7601		(267)991-7601												
H6560	001	0	1	01	01	H6560_001_0	3		1	08/06/2014	2015.01	08/06/2014 09:00:15 AM Eastern Daylight Time	08/04/2014 08:15:46 PM Eastern Daylight Time	08/01/2014 10:22:17 AM Eastern Daylight Time			08/06/2014 09:22:02 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plus Plan (HMO)	01	01		1			H6560	001	0	2015	Richmond, Danville and Tidewater Virginia		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6560	002	0	1	01	01	H6560_002_0	3		1	08/02/2014	2015.01	08/02/2014 02:14:14 PM Eastern Daylight Time	08/05/2014 10:16:26 AM Eastern Daylight Time	08/01/2014 10:22:26 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H6560	002	0	2015	Richmond and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6560	003	0	1	01	01	H6560_003_0	3		1	08/02/2014	2015.01	08/02/2014 02:14:05 PM Eastern Daylight Time	08/05/2014 10:18:16 AM Eastern Daylight Time	08/01/2014 10:22:36 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H6560	003	0	2015	Danville City and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6560	004	0	1	01	01	H6560_004_0	4		1	08/02/2014	2015.01	08/02/2014 02:13:55 PM Eastern Daylight Time	08/05/2014 10:20:04 AM Eastern Daylight Time	08/01/2014 10:22:46 AM Eastern Daylight Time			08/06/2014 08:20:20 AM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H6560	004	0	2015	Newport News and Surrounding Area		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6560	801	0	1	01	01	H6560_801_0	1		1	05/29/2014	2015.01	05/29/2014 09:22:31 AM Eastern Daylight Time	05/31/2014 02:50:04 PM Eastern Daylight Time				05/31/2014 04:53:33 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H6560	801	0	2015	Virginia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H6560	802	0	1	01	01	H6560_802_0	1		1	05/29/2014	2015.01	05/29/2014 09:27:41 AM Eastern Daylight Time	05/31/2014 02:51:20 PM Eastern Daylight Time				05/31/2014 04:53:33 PM Eastern Daylight Time	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H6560	802	0	2015	Virginia		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H6609	001	0	1	04	01	H6609_001_0	4		1	07/10/2014	2015.02	07/10/2014 01:07:50 PM Eastern Daylight Time	08/02/2014 11:42:14 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-001 (PPO)	01	04		1			H6609	001	0	2015	Select Counties in South Dakota		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	003	0	1	04	01	H6609_003_0	3		1	07/10/2014	2015.02	07/10/2014 01:20:07 PM Eastern Daylight Time	08/02/2014 11:34:33 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-003 (PPO)	01	04		1			H6609	003	0	2015	Omaha Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	004	0	1	04	01	H6609_004_0	2		1	07/10/2014	2015.02	07/10/2014 01:25:01 PM Eastern Daylight Time	07/09/2014 06:19:33 PM Eastern Daylight Time				07/14/2014 12:51:35 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-004 (PPO)	01	04		1			H6609	004	0	2015	Select Counties in IA, NE, ND and SD		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
H6609	005	0	1	04	01	H6609_005_0	5		1	07/10/2014	2015.02	07/10/2014 01:31:27 PM Eastern Daylight Time	08/02/2014 11:50:03 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:32:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-005 (PPO)	01	04		1			H6609	005	0	2015	Select Counties in Minnesota		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	006	0	1	04	01	H6609_006_0	2		1	07/10/2014	2015.02	07/10/2014 01:37:20 PM Eastern Daylight Time	07/09/2014 03:24:34 PM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-006 (PPO)	01	04		1			H6609	006	0	2015	Select Counties in Minnesota		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
H6609	009	0	1	04	01	H6609_009_0	3		1	07/10/2014	2015.02	07/10/2014 05:03:05 PM Eastern Daylight Time	08/05/2014 02:13:00 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-009 (PPO)	01	04		1			H6609	009	0	2015	Select Counties in Idaho and Oregon		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	012	0	1	04	01	H6609_012_0	2		1	07/10/2014	2015.02	07/10/2014 05:22:29 PM Eastern Daylight Time	07/11/2014 05:05:19 PM Eastern Daylight Time				07/14/2014 12:17:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-012 (PPO)	01	04		1			H6609	012	0	2015	Select Counties in ID, OR, WA and UT		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
H6609	013	0	1	04	01	H6609_013_0	3		1	07/11/2014	2015.02	07/11/2014 09:02:09 AM Eastern Daylight Time	08/05/2014 02:19:23 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-013 (PPO)	01	04		1			H6609	013	0	2015	Select Counties in Washington and Oregon		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	017	0	1	04	01	H6609_017_0	3		1	07/10/2014	2015.02	07/10/2014 01:42:57 PM Eastern Daylight Time	08/02/2014 11:55:26 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-017 (PPO)	01	04		1			H6609	017	0	2015	Select Counties in North Dakota		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	019	0	1	04	01	H6609_019_0	3		1	07/10/2014	2015.02	07/10/2014 01:47:44 PM Eastern Daylight Time	08/02/2014 11:59:46 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-019 (PPO)	01	04		1			H6609	019	0	2015	Select Counties in South Dakota		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	029	0	1	04	01	H6609_029_0	3		1	07/10/2014	2015.02	07/10/2014 01:52:51 PM Eastern Daylight Time	08/02/2014 12:49:57 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-029 (PPO)	01	04		1			H6609	029	0	2015	Cascade, Flathead and Ravalli counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	073	0	1	04	01	H6609_073_0	3		1	07/11/2014	2015.02	07/11/2014 09:02:43 AM Eastern Daylight Time	08/05/2014 02:21:49 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-073 (PPO)	01	04		1			H6609	073	0	2015	Select Counties in ID, OR and WA		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	074	0	1	04	01	H6609_074_0	3		1	07/10/2014	2015.02	07/10/2014 01:57:05 PM Eastern Daylight Time	08/02/2014 12:44:53 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-074 (PPO)	01	04		1			H6609	074	0	2015	Select Counties in Minnesota		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	075	0	1	04	01	H6609_075_0	3		1	07/10/2014	2015.02	07/10/2014 02:01:43 PM Eastern Daylight Time	08/02/2014 12:18:13 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-075 (PPO)	01	04		1			H6609	075	0	2015	Carbon, Stillwater and Yellowstone counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	077	0	1	04	01	H6609_077_0	3		1	08/02/2014	2015.02	08/02/2014 12:21:59 PM Eastern Daylight Time	08/04/2014 10:09:32 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:55:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-077 (PPO)	01	04		1			H6609	077	0	2015	Louisville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	078	0	1	04	01	H6609_078_0	3		1	07/10/2014	2015.02	07/10/2014 02:05:54 PM Eastern Daylight Time	08/02/2014 08:07:41 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-078 (PPO)	01	04		1			H6609	078	0	2015	Lexington Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	080	0	1	04	01	H6609_080_0	3		1	07/10/2014	2015.02	07/10/2014 02:10:45 PM Eastern Daylight Time	08/02/2014 07:57:23 PM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-080 (PPO)	01	04		1			H6609	080	0	2015	Barren, Metcalfe and Warren counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	081	0	1	04	01	H6609_081_0	4		1	07/15/2014	2015.02	07/15/2014 09:37:55 AM Eastern Daylight Time	08/05/2014 09:37:17 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-081 (PPO)	01	04		1			H6609	081	0	2015	Cincinnati and Dayton Areas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	082	0	1	04	01	H6609_082_0	3		1	07/10/2014	2015.02	07/10/2014 01:21:20 PM Eastern Daylight Time	08/05/2014 09:55:06 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-082 (PPO)	01	04		1			H6609	082	0	2015	Cleveland Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	083	0	1	04	01	H6609_083_0	3		1	07/10/2014	2015.02	07/10/2014 01:22:57 PM Eastern Daylight Time	08/05/2014 09:38:20 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-083 (PPO)	01	04		1			H6609	083	0	2015	Columbus Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	084	0	1	04	01	H6609_084_0	3		1	07/10/2014	2015.02	07/10/2014 01:24:57 PM Eastern Daylight Time	08/05/2014 09:40:13 AM Eastern Daylight Time	08/04/2014 05:04:15 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-084 (PPO)	01	04		1			H6609	084	0	2015	Northwest Ohio Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	085	0	1	04	01	H6609_085_0	4		1	07/10/2014	2015.02	07/10/2014 01:27:24 PM Eastern Daylight Time	08/05/2014 09:39:53 AM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-085 (PPO)	01	04		1			H6609	085	0	2015	Canton Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	086	0	1	04	01	H6609_086_0	3		1	07/10/2014	2015.02	07/10/2014 01:29:17 PM Eastern Daylight Time	08/05/2014 09:52:35 AM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 11:27:18 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-086 (PPO)	01	04		1			H6609	086	0	2015	Ohio Valley Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	088	0	1	04	01	H6609_088_0	3		1	07/11/2014	2015.02	07/11/2014 02:55:34 PM Eastern Daylight Time	08/02/2014 01:19:42 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-088 (PPO)	01	04		1			H6609	088	0	2015	Memphis Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	089	0	1	04	01	H6609_089_0	3		1	07/11/2014	2015.02	07/11/2014 02:57:38 PM Eastern Daylight Time	08/02/2014 01:21:27 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 01:37:06 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-089 (PPO)	01	04		1			H6609	089	0	2015	Nashville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	090	0	1	04	01	H6609_090_0	3		1	07/11/2014	2015.02	07/11/2014 03:00:06 PM Eastern Daylight Time	08/02/2014 01:21:06 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-090 (PPO)	01	04		1			H6609	090	0	2015	Chattanooga Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	091	0	1	04	01	H6609_091_0	3		1	07/11/2014	2015.02	07/11/2014 03:02:14 PM Eastern Daylight Time	08/02/2014 01:11:29 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-091 (PPO)	01	04		1			H6609	091	0	2015	Knoxville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	092	0	1	04	01	H6609_092_0	3		1	07/11/2014	2015.02	07/11/2014 03:04:28 PM Eastern Daylight Time	08/02/2014 01:14:13 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:28:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-092 (PPO)	01	04		1			H6609	092	0	2015	Select Counties in the Tri-Cities Area of Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	095	0	1	04	01	H6609_095_0	4		1	07/10/2014	2015.02	07/10/2014 02:26:13 PM Eastern Daylight Time	08/03/2014 06:10:26 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-095 (PPO)	01	04		1			H6609	095	0	2015	Northeast Virginia area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	096	0	1	04	01	H6609_096_0	5		1	07/10/2014	2015.02	07/10/2014 02:25:45 PM Eastern Daylight Time	08/03/2014 06:10:04 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-096 (PPO)	01	04		1			H6609	096	0	2015	Northern Virginia area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	097	0	1	04	01	H6609_097_0	3		1	07/11/2014	2015.02	07/11/2014 08:20:36 AM Eastern Daylight Time	08/02/2014 01:11:50 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-097 (PPO)	01	04		1			H6609	097	0	2015	Huntsville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	098	0	1	04	01	H6609_098_0	3		1	07/10/2014	2015.02	07/10/2014 02:24:58 PM Eastern Daylight Time	08/03/2014 06:13:00 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-098 (PPO)	01	04		1			H6609	098	0	2015	Richmond Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	099	0	1	04	01	H6609_099_0	3		1	08/01/2014	2015.02	08/01/2014 02:30:05 PM Eastern Daylight Time	08/02/2014 01:11:08 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-099 (PPO)	01	04		1			H6609	099	0	2015	Birmingham Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	100	0	1	04	01	H6609_100_0	3		1	07/10/2014	2015.02	07/10/2014 02:00:50 PM Eastern Daylight Time	08/03/2014 06:05:14 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-100 (PPO)	01	04		1			H6609	100	0	2015	Roanoke Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	101	0	1	04	01	H6609_101_0	3		1	07/10/2014	2015.02	07/10/2014 02:00:14 PM Eastern Daylight Time	08/03/2014 06:03:00 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-101 (PPO)	01	04		1			H6609	101	0	2015	Tidewater area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	102	0	1	04	01	H6609_102_0	3		1	07/10/2014	2015.02	07/10/2014 01:59:16 PM Eastern Daylight Time	08/03/2014 06:12:17 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-102 (PPO)	01	04		1			H6609	102	0	2015	Kent and New Castle counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	103	0	1	04	01	H6609_103_0	3		1	07/10/2014	2015.02	07/10/2014 01:58:48 PM Eastern Daylight Time	08/03/2014 06:12:37 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-103 (PPO)	01	04		1			H6609	103	0	2015	Allegany, Garrett and Washington counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	104	0	1	04	01	H6609_104_0	3		1	08/04/2014	2015.02	08/04/2014 11:53:46 AM Eastern Daylight Time	08/04/2014 12:57:13 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-104 (PPO)	01	04		1			H6609	104	0	2015	Select Louisiana Parishes		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	105	0	1	04	01	H6609_105_0	3		1	07/10/2014	2015.02	07/10/2014 01:44:19 PM Eastern Daylight Time	08/02/2014 12:40:15 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-105 (PPO)	01	04		1			H6609	105	0	2015	Gulf Coast / Biloxo Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	106	0	1	04	01	H6609_106_0	4		1	07/24/2014	2015.02	07/24/2014 05:04:27 PM Eastern Daylight Time	08/02/2014 12:39:56 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-106 (PPO)	01	04		1			H6609	106	0	2015	Select Mississippi Counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	107	0	1	04	01	H6609_107_0	3		1	07/11/2014	2015.02	07/11/2014 01:43:22 PM Eastern Daylight Time	08/02/2014 12:40:53 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-107 (PPO)	01	04		1			H6609	107	0	2015	Grenada, Lafayette and Yalobusha Counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	108	0	1	04	01	H6609_108_0	3		1	08/02/2014	2015.02	08/02/2014 02:52:47 PM Eastern Daylight Time	08/05/2014 02:09:08 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-108 (PPO)	01	04		1			H6609	108	0	2015	Select Counties in Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	109	0	1	04	01	H6609_109_0	3		1	07/10/2014	2015.02	07/10/2014 01:22:31 PM Eastern Daylight Time	08/05/2014 02:18:43 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:20:48 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-109 (PPO)	01	04		1			H6609	109	0	2015	Select Counties in Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	110	0	1	04	01	H6609_110_0	3		1	08/02/2014	2015.02	08/02/2014 03:07:35 PM Eastern Daylight Time	08/04/2014 02:34:53 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-110 (PPO)	01	04		1			H6609	110	0	2015	Colorado's I-25 Corridor/Grand Junction Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	111	0	1	04	01	H6609_111_0	3		1	07/23/2014	2015.02	07/23/2014 04:48:01 PM Eastern Daylight Time	07/24/2014 11:52:15 AM Eastern Daylight Time				07/24/2014 12:34:42 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-111 (PPO)	01	04		1			H6609	111	0	2015	Select Counties in Colorado and New Mexico		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
H6609	112	0	1	04	01	H6609_112_0	3		1	07/10/2014	2015.02	07/10/2014 12:58:31 PM Eastern Daylight Time	08/04/2014 02:41:59 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-112 (PPO)	01	04		1			H6609	112	0	2015	Colorado's I-25 Corridor/Grand Junction Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	113	0	1	04	01	H6609_113_0	3		1	07/10/2014	2015.02	07/10/2014 12:59:38 PM Eastern Daylight Time	08/04/2014 02:47:29 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-113 (PPO)	01	04		1			H6609	113	0	2015	Colorado's I-25 Corridor/Grand Junction Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	114	0	1	04	01	H6609_114_0	3		1	08/02/2014	2015.02	08/02/2014 03:09:37 PM Eastern Daylight Time	08/04/2014 02:43:43 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-114 (PPO)	01	04		1			H6609	114	0	2015	Dona Ana, Luna and Otero counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	115	0	1	04	01	H6609_115_0	4		1	07/10/2014	2015.02	07/10/2014 01:05:31 PM Eastern Daylight Time	08/04/2014 02:45:18 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-115 (PPO)	01	04		1			H6609	115	0	2015	Select Counties in New Mexico		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	116	0	1	04	01	H6609_116_0	3		1	07/10/2014	2015.02	07/10/2014 02:20:55 PM Eastern Daylight Time	08/02/2014 07:56:45 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-116 (PPO)	01	04		1			H6609	116	0	2015	Charleston-Huntington Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	117	0	1	04	01	H6609_117_0	3		1	07/10/2014	2015.02	07/10/2014 02:27:10 PM Eastern Daylight Time	08/02/2014 07:57:40 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-117 (PPO)	01	04		1			H6609	117	0	2015	Martinsburg Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	118	0	1	04	01	H6609_118_0	3		1	07/11/2014	2015.02	07/11/2014 09:42:22 AM Eastern Daylight Time	08/02/2014 01:13:31 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-118 (PPO)	01	04		1			H6609	118	0	2015	Montgomery Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	119	0	1	04	01	H6609_119_0	3		1	07/11/2014	2015.02	07/11/2014 10:08:28 AM Eastern Daylight Time	08/02/2014 01:13:11 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 09:13:39 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-119 (PPO)	01	04		1			H6609	119	0	2015	Dothan Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	120	0	1	04	01	H6609_120_0	6		1	08/06/2014	2015.01	08/06/2014 05:12:12 PM Eastern Daylight Time	08/05/2014 09:40:39 AM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-120 (PPO)	01	04		1			H6609	120	0	2015	Greater Georgia Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	121	0	1	04	01	H6609_121_0	3		1	07/11/2014	2015.01	07/11/2014 09:04:20 AM Eastern Daylight Time	08/04/2014 02:48:24 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-121 (PPO)	01	04		1			H6609	121	0	2015	Select Counties in Oklahoma		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	122	0	1	04	01	H6609_122_0	4		1	08/06/2014	2015.01	08/06/2014 04:05:32 PM Eastern Daylight Time	08/05/2014 09:41:49 AM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-122 (PPO)	01	04		1			H6609	122	0	2015	Atlanta Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	123	0	1	04	01	H6609_123_0	3		1	07/10/2014	2015.01	07/10/2014 01:56:56 PM Eastern Daylight Time	08/04/2014 02:38:07 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-123 (PPO)	01	04		1			H6609	123	0	2015	Select Counties in AR, KS and MO		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	124	0	1	04	01	H6609_124_0	4		1	08/06/2014	2015.01	08/06/2014 04:07:52 PM Eastern Daylight Time	08/05/2014 09:35:32 AM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-124 (PPO)	01	04		1			H6609	124	0	2015	Charleston Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	125	0	1	04	01	H6609_125_0	6		1	08/06/2014	2015.01	08/06/2014 04:11:23 PM Eastern Daylight Time	08/05/2014 11:18:12 AM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-125 (PPO)	01	04		1			H6609	125	0	2015	Greater North Carolina Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	126	0	1	04	01	H6609_126_0	3		1	07/11/2014	2015.01	07/11/2014 09:04:47 AM Eastern Daylight Time	08/04/2014 02:49:18 PM Eastern Daylight Time	08/04/2014 05:04:16 PM Eastern Daylight Time			08/06/2014 08:23:27 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-126 (PPO)	01	04		1			H6609	126	0	2015	Select Counties in AR, KS, MO and OK		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	127	0	1	04	01	H6609_127_0	4		1	08/06/2014	2015.01	08/06/2014 04:14:07 PM Eastern Daylight Time	08/05/2014 09:35:50 AM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-127 (PPO)	01	04		1			H6609	127	0	2015	Spartanburg/Greenville Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	128	0	1	04	01	H6609_128_0	4		1	07/10/2014	2015.02	07/10/2014 05:22:55 PM Eastern Daylight Time	08/05/2014 02:25:05 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:00:10 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-128 (PPO)	01	04		1			H6609	128	0	2015	Select Counties in Utah		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	129	0	1	04	01	H6609_129_0	3		1	07/10/2014	2015.02	07/10/2014 01:31:52 PM Eastern Daylight Time	08/04/2014 05:15:51 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/05/2014 05:26:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-129 (PPO)	01	04		1			H6609	129	0	2015	Clark County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	130	0	1	04	01	H6609_130_0	3		1	07/10/2014	2015.02	07/10/2014 04:47:18 PM Eastern Daylight Time	08/04/2014 05:19:25 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/05/2014 05:26:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-130 (PPO)	01	04		1			H6609	130	0	2015	Clark County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	131	0	1	04	01	H6609_131_0	3		1	07/10/2014	2015.02	07/10/2014 04:48:17 PM Eastern Daylight Time	08/04/2014 05:16:28 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/05/2014 05:26:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-131 (PPO)	01	04		1			H6609	131	0	2015	Washoe County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	132	0	1	04	01	H6609_132_0	3		1	07/10/2014	2015.02	07/10/2014 04:48:49 PM Eastern Daylight Time	08/04/2014 05:18:14 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/05/2014 05:26:01 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-132 (PPO)	01	04		1			H6609	132	0	2015	Washoe County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	133	0	1	04	01	H6609_133_0	3		1	07/22/2014	2015.02	07/22/2014 08:24:55 AM Eastern Daylight Time	08/04/2014 05:09:48 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-133 (PPO)	01	04		1			H6609	133	0	2015	Maricopa County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	134	0	1	04	01	H6609_134_0	3		1	07/10/2014	2015.02	07/10/2014 01:07:30 PM Eastern Daylight Time	08/04/2014 05:01:14 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-134 (PPO)	01	04		1			H6609	134	0	2015	Pima, Pinal and Santa Cruz counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	135	0	1	04	01	H6609_135_0	3		1	07/10/2014	2015.02	07/10/2014 01:10:31 PM Eastern Daylight Time	08/04/2014 05:05:21 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-135 (PPO)	01	04		1			H6609	135	0	2015	La Paz and Mohave counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	136	0	1	04	01	H6609_136_0	3		1	07/10/2014	2015.02	07/10/2014 01:13:34 PM Eastern Daylight Time	08/04/2014 05:04:04 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-136 (PPO)	01	04		1			H6609	136	0	2015	Yavapai County		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	137	0	1	04	01	H6609_137_0	3		1	07/10/2014	2015.02	07/10/2014 01:19:04 PM Eastern Daylight Time	08/04/2014 05:01:47 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-137 (PPO)	01	04		1			H6609	137	0	2015	Honolulu, Kauai and Maui counties		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	138	0	1	04	01	H6609_138_0	3		1	07/10/2014	2015.02	07/10/2014 02:06:22 PM Eastern Daylight Time	08/02/2014 12:57:36 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-138 (PPO)	01	04		1			H6609	138	0	2015	Select Counties in Iowa		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	139	0	1	04	01	H6609_139_0	2		1	07/10/2014	2015.02	07/10/2014 02:11:11 PM Eastern Daylight Time	07/10/2014 12:23:42 PM Eastern Daylight Time				07/14/2014 01:21:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-139 (PPO)	01	04		1			H6609	139	0	2015	Select Counties in Iowa		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
H6609	140	0	1	04	01	H6609_140_0	4		1	07/10/2014	2015.02	07/10/2014 02:15:47 PM Eastern Daylight Time	08/02/2014 01:03:11 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice H6609-140 (PPO)	01	04		1			H6609	140	0	2015	Select Counties in Iowa		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6609	801	0	1	04	01	H6609_801_0	2		1	05/27/2014	2015.02	05/27/2014 02:46:59 PM Eastern Daylight Time	07/14/2014 10:35:16 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H6609	801	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	802	0	1	04	01	H6609_802_0	2		1	05/27/2014	2015.02	05/27/2014 02:47:44 PM Eastern Daylight Time	07/14/2014 10:24:23 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H6609	802	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	803	0	1	04	01	H6609_803_0	2		1	05/23/2014	2015.02	05/23/2014 02:00:11 PM Eastern Daylight Time	07/14/2014 10:31:35 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		1			H6609	803	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	805	0	2	04	01	H6609_805_0	2		1	05/28/2014	2015.02	05/28/2014 03:10:42 PM Eastern Daylight Time	07/14/2014 10:28:34 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H6609	805	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	806	0	2	04	01	H6609_806_0	2		1	05/28/2014	2015.02	05/28/2014 03:11:11 PM Eastern Daylight Time	07/14/2014 10:34:05 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		2	1		H6609	806	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	807	0	2	04	01	H6609_807_0	2		1	05/28/2014	2015.02	05/28/2014 03:11:35 PM Eastern Daylight Time	07/14/2014 10:29:59 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (PPO)	01	04		2	1		H6609	807	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	814	0	1	04	01	H6609_814_0	2		1	05/23/2014	2015.02	05/23/2014 02:00:21 PM Eastern Daylight Time	07/14/2014 10:26:22 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer - Walmart (PPO)	01	04		1			H6609	814	0	2015	Select Counties in Multi-States		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6609	816	0	1	04	01	H6609_816_0	2		1	05/27/2014	2015.02	05/27/2014 01:30:25 PM Eastern Daylight Time	07/14/2014 10:26:43 AM Eastern Daylight Time				07/14/2014 01:15:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PPO)	01	04		1			H6609	816	0	2015	Bexar County		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
H6622	001	0	1	01	01	H6622_001_0	3		1	08/02/2014	2015.02	08/02/2014 11:06:14 AM Eastern Daylight Time	08/04/2014 10:15:01 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-001 (HMO)	01	01		1			H6622	001	0	2015	Green Bay area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6622	002	0	1	01	01	H6622_002_0	3		1	07/10/2014	2015.02	07/10/2014 01:22:47 PM Eastern Daylight Time	08/04/2014 10:16:30 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-002 (HMO)	01	01		1			H6622	002	0	2015	Milwaukee area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6622	003	0	1	01	01	H6622_003_0	3		1	08/04/2014	2015.02	08/04/2014 11:13:08 AM Eastern Daylight Time	08/04/2014 10:28:23 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-003 (HMO)	01	01		1			H6622	003	0	2015	Western Wisconsin area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6622	004	0	1	01	01	H6622_004_0	3		1	08/02/2014	2015.02	08/02/2014 08:57:45 AM Eastern Daylight Time	08/03/2014 06:13:22 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-004 (HMO)	01	01		1			H6622	004	0	2015	Richmond Metro Area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6622	005	0	1	01	01	H6622_005_0	4		1	08/02/2014	2015.02	08/02/2014 08:57:11 AM Eastern Daylight Time	08/03/2014 06:13:43 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-005 (HMO)	01	01		1			H6622	005	0	2015	Tidewater area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6622	007	0	1	01	01	H6622_007_0	3		1	07/10/2014	2015.02	07/10/2014 02:21:20 PM Eastern Daylight Time	08/02/2014 12:53:26 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Gold Plus H6622-007 (HMO)	01	01		1			H6622	007	0	2015	Cedar Rapids Metro area		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6622	801	0	1	01	01	H6622_801_0	3		1	05/23/2014	2015.02	05/23/2014 02:56:09 PM Eastern Daylight Time	07/14/2014 11:00:19 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6622	801	0	2015	Select counties in Montana and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H6622	802	0	1	01	01	H6622_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:56:55 PM Eastern Daylight Time	07/14/2014 11:00:57 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Humana WI Health Organization Insurance Corp	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6622	802	0	2015	Select counties in Montana and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H6623	001	0	1	01	01	H6623_001_0	6	2	1	08/05/2014	2015.01	08/05/2014 03:20:37 PM US Mountain Standard Time	08/07/2014 11:43:31 AM US Mountain Standard Time	08/05/2014 04:36:00 PM US Mountain Standard Time			08/07/2014 11:46:32 AM US Mountain Standard Time	MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT	Maricopa Care Advantage	www.mcareaz.com	Maricopa Care Advantage (HMO SNP)	01	01		1			H6623	001	0	2015	Maricopa County		2	1619	2			1	3		1	4			www.mcareaz.com/ProviderLookup.aspx	www.mcareaz.com/PartDResources.aspx	www.mcareaz.com/PharmacyLookup.aspx	(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(877)874-3935		(520)874-3935		(877)874-3938		(520)874-3938		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6743	001	0	1	04	01	H6743_001_0	5		1	07/31/2014	2015.01	07/31/2014 03:32:20 PM Pacific Daylight Time	08/06/2014 01:11:24 PM Pacific Daylight Time	08/06/2014 01:11:29 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Basin) (PPO)	01	04		1			H6743	001	0	2015	Klamath County		2	1411	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	002	0	1	04	01	H6743_002_0	4		1	07/17/2014	2015.01	07/17/2014 02:48:09 PM Pacific Daylight Time	07/18/2014 07:12:51 PM Pacific Daylight Time				07/22/2014 03:27:33 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver (PPO)	01	04		1			H6743	002	0	2015	Douglas and Klamath Counties		2	288	1	1		2							www.atriohp.om	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2					
H6743	003	0	1	04	01	H6743_003_0	6		1	07/18/2014	2015.01	07/18/2014 10:57:46 AM Pacific Daylight Time	08/06/2014 01:11:34 PM Pacific Daylight Time	08/06/2014 01:11:39 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver Rx (PPO)	01	04		1			H6743	003	0	2015	Douglas and Klamath Counties		2	936	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	004	0	1	04	01	H6743_004_0	6		1	07/24/2014	2015.01	07/24/2014 10:59:56 AM Pacific Daylight Time	08/06/2014 01:11:45 PM Pacific Daylight Time	08/06/2014 01:11:50 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Gold Rx (PPO)	01	04		1			H6743	004	0	2015	Douglas and Klamath Counties		2	789	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	005	0	1	04	01	H6743_005_0	6		1	07/18/2014	2015.01	07/18/2014 08:57:38 AM Pacific Daylight Time	08/06/2014 01:11:55 PM Pacific Daylight Time	08/06/2014 01:12:00 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Platinum Rx (PPO)	01	04		1			H6743	005	0	2015	Douglas and Klamath Counties		2	516	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	006	0	1	04	01	H6743_006_0	3		1	06/27/2014	2015.01	06/27/2014 02:12:25 PM Pacific Daylight Time	07/18/2014 07:14:09 PM Pacific Daylight Time				07/22/2014 03:27:33 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze (PPO)	01	04		1			H6743	006	0	2015	Douglas and Klamath Counties		2	374	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2					
H6743	007	0	1	04	01	H6743_007_0	5		1	08/06/2014	2015.01	08/06/2014 01:47:17 PM Pacific Daylight Time	08/06/2014 01:12:06 PM Pacific Daylight Time	08/06/2014 01:12:11 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Umpqua) (PPO)	01	04		1			H6743	007	0	2015	Douglas County		2	1751	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	013	0	1	04	01	H6743_013_0	4		1	07/17/2014	2015.01	07/17/2014 02:57:07 PM Pacific Daylight Time	07/18/2014 07:14:47 PM Pacific Daylight Time				07/22/2014 03:27:33 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze (Rogue) (PPO)	01	04		1			H6743	013	0	2015	Josephine County		2	70	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2					
H6743	014	0	1	04	01	H6743_014_0	7		1	07/18/2014	2015.01	07/18/2014 09:13:22 AM Pacific Daylight Time	08/08/2014 02:59:33 PM Pacific Daylight Time	08/06/2014 01:12:21 PM Pacific Daylight Time			08/08/2014 03:22:03 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Rogue) (PPO)	01	04		1			H6743	014	0	2015	Josephine County		2	532	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	015	0	1	04	01	H6743_015_0	4		1	07/17/2014	2015.01	07/17/2014 02:58:53 PM Pacific Daylight Time	07/18/2014 07:15:26 PM Pacific Daylight Time				07/22/2014 03:27:33 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver (Rogue) (PPO)	01	04		1			H6743	015	0	2015	Josephine County		2	70	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2					
H6743	016	0	1	04	01	H6743_016_0	6		1	07/18/2014	2015.01	07/18/2014 09:15:37 AM Pacific Daylight Time	08/06/2014 01:12:27 PM Pacific Daylight Time	08/06/2014 01:12:32 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver Rx (Rogue) (PPO)	01	04		1			H6743	016	0	2015	Josephine County		2	364	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6743	017	0	1	04	01	H6743_017_0	6		1	07/24/2014	2015.01	07/24/2014 01:12:01 PM Pacific Daylight Time	08/06/2014 01:12:37 PM Pacific Daylight Time	08/06/2014 01:12:42 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Gold Rx (Rogue) (PPO)	01	04		1			H6743	017	0	2015	Josephine County		2	364	1	1		2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H6745	001	0	1	01	01	H6745_001_0	8		1	08/14/2014	2015.01	08/14/2014 01:15:52 PM Eastern Daylight Time	08/05/2014 01:31:40 PM Eastern Daylight Time	08/06/2014 11:35:58 AM Eastern Daylight Time			08/14/2014 01:16:41 PM Eastern Daylight Time	AMIDA CARE INC.	Amida Care	www.amidacareny.org	Amida Care True Life Plus (HMO)	01	01		1			H6745	001	0	2015	Bronx,Kings,New York,Queens,Richmond Counties		2	163	2			2							www.amidacareny.org	www.amidacareny.org	www.amidacareny.org	(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6745	002	0	1	01	01	H6745_002_0	5	2	1	08/06/2014	2015.01	08/06/2014 10:51:15 AM Eastern Daylight Time	08/05/2014 01:32:24 PM Eastern Daylight Time	08/06/2014 11:29:38 AM Eastern Daylight Time			08/06/2014 03:01:29 PM Eastern Daylight Time	AMIDA CARE INC.	Amida Care	www.amidacareny.org	Amida Care True Life Advantage (HMO SNP)	01	01		1			H6745	002	0	2015	Bronx,Kings,New York,Queens,Richmond Counties		2	216	2			1	3		1	3		1	www.amidacareny.org	www.amidacareny.org	www.amidacareny.org	(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6745	003	0	1	01	01	H6745_003_0	5		1	08/06/2014	2015.01	08/06/2014 10:51:36 AM Eastern Daylight Time	08/05/2014 01:33:02 PM Eastern Daylight Time	08/06/2014 11:29:20 AM Eastern Daylight Time			08/06/2014 03:03:01 PM Eastern Daylight Time	AMIDA CARE INC.	Amida Care	www.amidacareny.org	Amida Care Live Life Advantage (HMO SNP)	01	01		1			H6745	003	0	2015	Bronx,Kings,New York,Queens,Richmond Counties		2	704	2			1	4		1		00000000001000000000		www.amidacareny.org	www.amidacareny.org	www.amidacareny.org	(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(888)963-7092		(888)963-7092		(888)963-7093		(888)963-7093		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6750	001	0	1	01	01	H6750_001_0	8		1	09/12/2014	2015.01	09/12/2014 12:31:56 PM Eastern Daylight Time	09/08/2014 03:48:57 PM Eastern Daylight Time	09/08/2014 04:01:04 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	001	0	2015	Southern New Hampshire		2	2883	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H6750	002	0	1	01	01	H6750_002_0	8		1	09/12/2014	2015.01	09/12/2014 03:13:44 PM Eastern Daylight Time	09/08/2014 03:49:50 PM Eastern Daylight Time	09/08/2014 04:01:55 PM Eastern Daylight Time			09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx (HMO)	01	01		1			H6750	002	0	2015	Southern New Hampshire		2	2883	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H6750	801	0	1	01	01	H6750_801_0	5		1	09/12/2014	2015.01	09/12/2014 01:54:03 PM Eastern Daylight Time	09/09/2014 05:43:24 PM Eastern Daylight Time				09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	801	0	2015	National		1	72	1	1		2							www.harvardpilgrim.org	www.harvardpilgrim.org	www.harvardpilgrim.org	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H6750	802	0	1	01	01	H6750_802_0	5		1	09/12/2014	2015.01	09/12/2014 01:54:10 PM Eastern Daylight Time	09/09/2014 05:44:13 PM Eastern Daylight Time				09/12/2014 03:20:35 PM Eastern Daylight Time	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Harvard Pilgrim Health Care of New England, Inc.	www.harvardpilgrim.org/medicare	Harvard Pilgrim Stride Value Rx Plus (HMO)	01	01		1			H6750	802	0	2015	National		1	72	1	1		2							www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	www.harvardpilgrim.org/medicare	(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(888)609-0692		(888)609-0692		(877)431-4742		(877)431-4742		(800)439-2370		(800)439-2370		(711)-		(711)-		(800)439-2370		(800)439-2370		(711)-		(711)-		2					2					2
H6751	001	0	1	48	05	H6751_001_0	4		1	07/10/2014	2015.02	07/10/2014 01:45:25 PM Central Daylight Time					07/14/2014 09:57:02 PM Central Daylight Time	HEALTHSPRING OF TENNESSEE, INC.	Cigna-HealthSpring CarePlan of Illinois	www.CarePlanIL.com	Cigna-HealthSpring CarePlan of Illinois (Medicare-Medicaid Plan)	05	48		1			H6751	001	0	2015	Greater Chicago Area		2		2			2							www.CarePlanIL.com	www.CarePlanIL.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(800)668-3813		(800)668-3813		(888)886-1993		(888)886-1993		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6786	002	0	1	04	01	H6786_002_0	15		1	07/01/2014	2015.01	07/01/2014 12:11:55 PM Pacific Daylight Time	08/05/2014 11:53:20 PM Pacific Daylight Time	08/01/2014 02:31:16 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Premier (PPO)	01	04		1			H6786	002	0	2015	Select Counties in Maine		2	576	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1785		(855)304-1785		(800)797-6458		(800)797-6458		(855)304-1785		(855)304-1785		(800)797-6458		(800)797-6458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H6786	801	0	1	04	01	H6786_801_0	7		1	05/30/2014	2015.01	05/30/2014 03:10:46 PM Pacific Daylight Time	07/15/2014 03:52:31 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H6786	801	0	2015	Maine		1	122	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H6786	802	0	1	04	01	H6786_802_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:49 PM Pacific Daylight Time	07/15/2014 03:52:39 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H6786	802	0	2015	Maine		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H6786	803	0	1	04	01	H6786_803_0	6		1	05/30/2014	2015.01	05/30/2014 03:10:53 PM Pacific Daylight Time	07/15/2014 03:52:56 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H6786	803	0	2015	Maine		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(855)320-6555		(855)320-6555		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H6787	001	0	1	20	08	H6787_001_0	1		1	10/01/2014	2015.01	10/01/2014 01:39:26 PM Eastern Daylight Time		09/10/2014 03:10:20 PM Eastern Daylight Time			10/01/2014 01:42:34 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	Senior Community Care of Michigan	http://seniorcommunitycaremi.org	VOANS Senior Community Care of Michigan (PACE)	08	20		1			H6787	001	0	2015	Ingham, Eaton, and Clinton Counties		2		2			2								http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org									(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000												
H6787	002	0	1	20	08	H6787_002_0	1		1	10/01/2014	2015.01	10/01/2014 01:39:47 PM Eastern Daylight Time		09/10/2014 03:10:38 PM Eastern Daylight Time			10/01/2014 01:42:34 PM Eastern Daylight Time	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	Senior Community Care of Michigan	http://seniorcommunitycaremi.org	VOANS Senior Community Care of Michigan (PACE)	08	20		1			H6787	002	0	2015	Eaton, Ingham and Clinton County		2		2			2								http://seniorcommunitycaremi.org	http://seniorcommunitycaremi.org									(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000										(000)000-0000		(000)000-0000		(000)000-0000		(000)000-0000												
H6801	002	0	1	01	01	H6801_002_0	14		1	08/06/2014	2015.01	08/06/2014 08:54:47 AM Central Daylight Time	08/05/2014 04:28:46 PM Central Daylight Time	08/05/2014 09:50:50 AM Central Daylight Time			08/06/2014 10:04:37 AM Central Daylight Time	AHS-TULSA OKLAHOMA HEALTH PLAN, INC.	Lovelace Medicare Plan	www.mylovelacemedicareok.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H6801	002	0	2015	Greater Oklahoma Area		2	3378	2			2							www.mylovelacemedicareok.com	www.mylovelacemedicareok.com	www.mylovelacemedicareok.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6801	006	0	1	02	01	H6801_006_0	14		1	07/21/2014	2015.01	07/21/2014 01:42:24 PM Central Daylight Time	08/05/2014 04:14:30 PM Central Daylight Time	08/05/2014 09:52:58 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	AHS-TULSA OKLAHOMA HEALTH PLAN, INC.	Lovelace Medicare Plan	www.mylovelacemedicareok.com	Blue Cross Medicare Advantage Premier Plus (HMO-POS)	01	02		1			H6801	006	0	2015	Greater Oklahoma Area		2	90	2			2							www.mylovelacemedicareok.com	www.mylovelacemedicareok.com	www.mylovelacemedicareok.com	(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(877)895-6448		(877)895-6448		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6815	001	0	1	01	01	H6815_001_0	3		1	08/05/2014	2015.01	08/05/2014 09:05:00 AM Pacific Daylight Time	08/05/2014 12:37:10 PM Pacific Daylight Time	07/31/2014 08:03:32 PM Pacific Daylight Time			08/05/2014 05:47:54 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	www.healthnet.com/medicare	Health Net Ruby (HMO)	01	01		1			H6815	001	0	2015	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM		2		2			2							www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H6815	002	0	1	01	01	H6815_002_0	3		1	08/04/2014	2015.01	08/04/2014 03:29:32 PM Pacific Daylight Time	08/05/2014 09:49:08 AM Pacific Daylight Time	07/31/2014 08:05:12 PM Pacific Daylight Time			08/05/2014 05:47:54 PM Pacific Daylight Time	HEALTH NET HEALTH PLAN OF OREGON	Health Net Health Plan of Oregon, Inc.	www.healthnet.com/medicare	Health Net Jade (HMO SNP)	01	01		1			H6815	002	0	2015	OR Counties BE, CK, LA, LN, ML, MN, PK, WA, YM		2		2			1	4		1		00000000000000000010		www.healthnet.com/medicare	https://www.healthnet.com/medicare/pharmacy	https://www.healthnet.com/medicare/pharmacy	(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(888)445-8913		(888)445-8913		(800)949-6192		(800)949-6192		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		(800)929-9955		2					2					2
H6859	001	0	1	01	01	H6859_001_0	3		1	08/02/2014	2015.02	08/02/2014 08:59:51 AM Eastern Daylight Time	08/03/2014 06:11:10 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-001 (HMO)	01	01		1			H6859	001	0	2015	South Central Pennsylvania area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6859	003	0	1	01	01	H6859_003_0	3		1	08/02/2014	2015.02	08/02/2014 08:59:10 AM Eastern Daylight Time	08/03/2014 06:11:31 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-003 (HMO)	01	01		1			H6859	003	0	2015	Northeast Pennsylvania area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6859	004	0	1	01	01	H6859_004_0	3		1	08/02/2014	2015.02	08/02/2014 08:58:36 AM Eastern Daylight Time	08/03/2014 06:11:53 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:11:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-004 (HMO)	01	01		1			H6859	004	0	2015	Bucks, Chester, Delaware and Philadelphia counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6859	007	0	1	01	01	H6859_007_0	3		1	08/02/2014	2015.02	08/02/2014 12:06:31 PM Eastern Daylight Time	08/05/2014 09:49:39 AM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Gold Plus H6859-007 (HMO)	01	01		1			H6859	007	0	2015	Lawrence and Mercer counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6859	801	0	1	01	01	H6859_801_0	3		1	05/23/2014	2015.02	05/23/2014 02:57:37 PM Eastern Daylight Time	07/14/2014 11:16:54 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6859	801	0	2015	Select Counties in Pennslyvania		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H6859	802	0	1	01	01	H6859_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:58:21 PM Eastern Daylight Time	07/14/2014 11:17:27 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Humana Medical Plan of Pennsylvania, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H6859	802	0	2015	Select Counties in Pennsylvania		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H6864	001	0	1	02	01	H6864_001_0	13	2	1	08/01/2014	2015.01	08/01/2014 04:04:40 PM Eastern Daylight Time	08/01/2014 04:49:32 PM EDT	08/01/2014 04:43:56 PM EDT			08/01/2014 05:11:37 PM EDT	GUILDNET, INC.	GuildNet	www.guildnetny.org	GuildNet Gold (HMO-POS SNP)	01	02		1			H6864	001	0	2015	Bronx, Kings, New York, Queens, Nassau, Suffolk		2		2			1	3		1	5			www.guildnetny.org	www.LighthouseGuild.org	www.LighthouseGuild.org	(800)815-0000		(800)815-0000		(800)815-0000		(800)815-0000		(877)444-3973		(877)444-3973		(800)815-0000		(800)815-0000		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(866)248-0640		(866)248-0640		(800)662-1220		(800)662-1220		2					2					2
H6887	001	0	1	20	08	H6887_001_0	1		1	05/20/2014	2015.01	05/20/2014 01:06:05 PM Eastern Daylight Time		05/16/2014 08:12:17 PM Eastern Daylight Time			05/20/2014 01:11:08 PM Eastern Daylight Time	SOUTH JERSEY HEALTHCARE LIFE, INC.	Inspira Health Network LIFE	www.inspirahealthnetwork.org	Inspira Health Network LIFE (PACE)	08	20		1			H6887	001	0	2015	Inspira Health Network LIFE		2	245	2			2								http://www.inspirahealthnetwork.org/	http://www.inspirahealthnetwork.org/									(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516										(855)295-5433		(856)632-4516		(855)295-5433		(856)362-4516												
H6887	002	0	1	20	08	H6887_002_0	1		1	05/01/2014	2015.01	05/01/2014 03:02:50 PM Eastern Daylight Time		05/16/2014 08:21:34 PM Eastern Daylight Time			05/20/2014 01:11:08 PM Eastern Daylight Time	SOUTH JERSEY HEALTHCARE LIFE, INC.	Inspira Health Network LIFE	www.inspirahealthnetwork.org	Inspira Health Network LIFE (PACE)	08	20		1			H6887	002	0	2015	Inspira Health Network LIFE		2	245	2			2								http://www.inspirahealthnetwork.org/	http://www.inspirahealthnetwork.org/									(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516										(855)295-5433		(856)362-4516		(855)295-5433		(856)362-4516												
H6923	001	0	1	01	01	H6923_001_0	8		1	08/06/2014	2015.01	08/06/2014 10:48:41 PM Eastern Daylight Time	08/06/2014 10:41:16 PM Eastern Daylight Time	08/01/2014 10:22:56 AM Eastern Daylight Time			08/06/2014 10:54:47 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H6923	001	0	2015	Denver and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6923	005	0	1	01	01	H6923_005_0	8		1	08/06/2014	2015.01	08/06/2014 10:48:38 PM Eastern Daylight Time	08/06/2014 10:42:30 PM Eastern Daylight Time	08/01/2014 10:23:07 AM Eastern Daylight Time			08/06/2014 10:54:47 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Prime Plan (HMO)	01	01		1			H6923	005	0	2015	Denver and Surrounding Counties		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6923	801	0	1	01	01	H6923_801_0	3		1	05/23/2014	2015.01	05/23/2014 10:13:18 PM Eastern Daylight Time	07/24/2014 03:32:40 PM Eastern Daylight Time				07/24/2014 03:45:20 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H6923	801	0	2015	Colorado		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H6923	802	0	1	01	01	H6923_802_0	2		1	05/23/2014	2015.01	05/23/2014 10:17:46 PM Eastern Daylight Time	06/01/2014 01:26:08 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/ RX CY (HMO)	01	01		1			H6923	802	0	2015	Colorado		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H6941	001	0	1	20	08	H6941_001_0	1		1	11/04/2014	2015.03	11/04/2014 11:14:45 AM Central Standard Time		10/23/2014 03:19:18 PM Central Standard Time			11/04/2014 11:18:40 AM Central Standard Time	LIFE PACE	LIFE PACE, INC.	WWW.LIFESENIORSERVICES.ORG	LIFE PACE Dual Eligible 001 (PACE)	08	20		1			H6941	001	0	2015	Tulsa County		2		2			2								www.lifeseniorservices.org	www.carekinesis.com									(844)664-4440		(918)664-9000		(844)664-4440		(918)664-9000										(844)664-4440		(918)664-1234		(844)664-4440		(918)664-1234												
H6941	002	0	1	20	08	H6941_002_0	1		1	11/04/2014	2015.03	11/04/2014 11:15:16 AM Central Standard Time		10/23/2014 03:33:55 PM Central Standard Time			11/04/2014 11:18:40 AM Central Standard Time	LIFE PACE	LIFE PACE, INC.	WWW.LIFESENIORSERVICES.ORG	LIFE PACE Medicare Only 002 (PACE)	08	20		1			H6941	002	0	2015	Tulsa County		2		2			2								www.lifeseniorservices.org	www.carekinesis.com									(844)664-4440		(918)664-9000		(844)664-4440		(918)664-9000										(844)664-4440		(918)664-1234		(844)664-4440		(918)664-1234												
H6951	001	0	1	04	01	H6951_001_0	4		1	07/23/2014	2015.01	07/23/2014 04:17:55 PM Pacific Daylight Time	06/02/2014 08:40:27 PM Pacific Daylight Time				07/23/2014 06:47:33 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Pioneer (PPO)	01	04		1			H6951	001	0	2015	Lane County		2	73	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950										(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951										2					2					
H6951	002	0	1	04	01	H6951_002_0	6		1	07/23/2014	2015.01	07/23/2014 04:19:26 PM Pacific Daylight Time	08/05/2014 03:30:34 PM Pacific Daylight Time	08/04/2014 08:53:54 AM Pacific Daylight Time			08/06/2014 06:23:22 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Pioneer Rx (PPO)	01	04		1			H6951	002	0	2015	Lane County		2	48	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					
H6951	003	0	1	04	01	H6951_003_0	6		1	07/23/2014	2015.01	07/23/2014 04:20:48 PM Pacific Daylight Time	08/05/2014 03:32:02 PM Pacific Daylight Time	08/04/2014 08:54:34 AM Pacific Daylight Time			08/06/2014 06:23:22 PM Pacific Daylight Time	TRILLIUM COMMUNITY HEALTH PLAN	Trillium Advantage	www.TrilliumAdvantage.com	Trillium Advantage Voyager Rx (PPO)	01	04		1			H6951	003	0	2015	Lane County		2	98	2			2							www.TrilliumAdvantage.com/prov_search.php	http://www.trilliumadvantage.com/formulary.php	http://www.trilliumadvantage.com/resources.php	(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(800)910-3906		(541)431-1950		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		(866)279-9750		(541)431-1951		2					2					
H6972	001	0	1	01	01	H6972_001_0	4		1	07/16/2014	2015.02	07/16/2014 03:10:18 PM Central Daylight Time	05/29/2014 07:26:42 PM Central Daylight Time	07/31/2014 03:59:57 PM Central Daylight Time			08/05/2014 11:09:09 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H6972	001	0	2015	Select counties in Arkansas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6974	001	0	1	48	05	H6974_001_0	5		1	08/04/2014	2015.01	08/04/2014 03:11:21 PM Eastern Daylight Time					08/04/2014 04:21:02 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	Alphacare of New York, Inc.	www.alphacare.com	AlphaCare Signature FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H6974	001	0	2015	Kings, Queens, Bronx and New York Counties		2		2			2							www.alphacare.com	www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H6988	001	0	1	01	01	H6988_001_0	6		1	08/06/2014	2015.01	08/06/2014 04:44:09 PM Eastern Daylight Time	08/06/2014 11:22:42 AM Eastern Daylight Time	08/07/2014 04:14:08 PM Eastern Daylight Time			08/08/2014 08:55:44 AM Eastern Daylight Time	CENTERS PLAN FOR HEALTHY LIVING, LLC	Centers Plan for Healthy Living	www.centersplan.com	Advantage Care (HMO)	01	01		1			H6988	001	0	2015	Centers Plan		2	287	2			2							www.centersplan.com	www.centersplan.com	www.centersplan.com	(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(877)940-9330		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220		2					2					2
H7003	001	0	1	20	08	H7003_001_0	1		1	05/20/2014	2015.01	05/20/2014 12:48:08 PM Central Daylight Time		05/19/2014 10:31:26 AM Central Daylight Time			05/20/2014 12:49:39 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways	immanuelpathways.org	Immanuel Pathways-PACE NE (PACE)	08	20		1			H7003	001	0	2015	PACE Nebraska		2		2			2								www.immanuelpathways,org	http://www.immanuelpathways.org/									(800)000-0000		(402)829-2992		(800)000-0000		(402)829-2992										(800)829-2992		(402)829-2992		(800)829-2992		(402)829-2992												
H7003	002	0	1	20	08	H7003_002_0	1		1	05/20/2014	2015.01	05/20/2014 12:48:27 PM Central Daylight Time		05/19/2014 11:37:26 AM Central Daylight Time			05/20/2014 12:49:39 PM Central Daylight Time	PACE NEBRASKA	Immanuel Pathways	http://www.immanuelpathways.org/	Immanuel Pathways-PACE NE (PACE)	08	20		1			H7003	002	0	2015	PACE Nebraska		2		2			2								www.immanuelpathways,org	http://www.immanuelpathways.org/									(800)000-0000		(402)829-2992		(800)000-0000		(402)829-2992										(800)829-2992		(402)829-2992		(800)829-2992		(402)829-2992												
H7006	001	0	1	04	01	H7006_001_0	6		1	07/18/2014	2015.01	07/18/2014 09:22:05 AM Pacific Daylight Time	08/06/2014 01:12:48 PM Pacific Daylight Time	08/06/2014 01:12:53 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Gold Rx (Willamette) (PPO)	01	04		1			H7006	001	0	2015	Marion and Polk Counties in Oregon		2	2685	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H7006	003	0	1	04	01	H7006_003_0	7		1	07/18/2014	2015.01	07/18/2014 09:23:18 AM Pacific Daylight Time	08/06/2014 01:12:58 PM Pacific Daylight Time	08/06/2014 01:13:03 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver Rx (Willamette) (PPO)	01	04		1			H7006	003	0	2015	Marion and Polk Counties		2	161	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H7006	004	0	1	04	01	H7006_004_0	4		1	07/17/2014	2015.01	07/17/2014 03:00:56 PM Pacific Daylight Time	07/18/2014 07:17:05 PM Pacific Daylight Time				07/22/2014 03:27:33 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Silver (Willamette) (PPO)	01	04		1			H7006	004	0	2015	Marion and Polk Counties		2	306	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2					
H7006	005	0	1	04	01	H7006_005_0	6		1	07/18/2014	2015.01	07/18/2014 09:24:43 AM Pacific Daylight Time	08/06/2014 01:13:09 PM Pacific Daylight Time	08/06/2014 01:10:47 PM Pacific Daylight Time			08/06/2014 01:49:27 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze Rx (Willamette) (PPO)	01	04		1			H7006	005	0	2015	Marion and Polk Counties		2	91	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900		2					2					
H7006	006	0	1	04	01	H7006_006_0	4		1	07/18/2014	2015.01	07/18/2014 08:33:15 AM Pacific Daylight Time	07/18/2014 07:17:45 PM Pacific Daylight Time				07/22/2014 03:27:33 PM Pacific Daylight Time	ATRIO HEALTH PLANS	ATRIO Health Plans	www.atriohp.com	ATRIO Bronze (Willamette) (PPO)	01	04		1			H7006	006	0	2015	Marion and Polk Counties		2	44	2			2							www.atriohp.com	www.atriohp.com	www.atriohp.com	(877)672-8620		(541)672-8620		(877)672-8620		(541)672-8620										(800)735-2900		(541)735-2900		(800)735-2900		(541)735-2900										2					2					
H7020	001	0	1	01	01	H7020_001_0	4		1	07/16/2014	2015.02	07/16/2014 02:40:06 PM Central Daylight Time	05/29/2014 07:19:22 PM Central Daylight Time	07/31/2014 03:46:52 PM Central Daylight Time			08/05/2014 09:32:50 AM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H7020	001	0	2015	South Carolina		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7020	801	0	1	01	01	H7020_801_0	1		1	05/14/2014	2015.02	05/14/2014 10:16:46 AM Central Daylight Time	05/29/2014 07:19:42 PM Central Daylight Time				05/29/2014 11:27:39 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H7020	801	0	2015	South Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H7020	802	0	1	02	01	H7020_802_0	1		1	05/14/2014	2015.02	05/14/2014 10:16:26 AM Central Daylight Time	05/29/2014 07:20:02 PM Central Daylight Time				05/29/2014 11:27:39 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H7020	802	0	2015	South Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H7020	803	0	1	01	01	H7020_803_0	1		1	05/23/2014	2015.02	05/23/2014 08:51:59 AM Central Daylight Time	05/29/2014 07:20:22 PM Central Daylight Time				05/29/2014 11:27:39 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H7020	803	0	2015	South Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(886)659-3446		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H7020	804	0	1	02	01	H7020_804_0	1		1	05/14/2014	2015.02	05/14/2014 10:17:31 AM Central Daylight Time	05/29/2014 07:20:42 PM Central Daylight Time				05/29/2014 11:27:39 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H7020	804	0	2015	South Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H7020	805	0	1	01	01	H7020_805_0	1		1	05/14/2014	2015.02	05/14/2014 10:17:52 AM Central Daylight Time	05/29/2014 07:21:05 PM Central Daylight Time				05/29/2014 11:27:39 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H7020	805	0	2015	South Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H7020	806	0	1	02	01	H7020_806_0	1		1	05/14/2014	2015.02	05/14/2014 10:18:22 AM Central Daylight Time	05/29/2014 07:21:26 PM Central Daylight Time				05/29/2014 11:27:39 PM Central Daylight Time	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H7020	806	0	2015	South Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H7114	001	0	1	20	08	H7114_001_0	1		1	10/17/2014	2015.03	10/17/2014 09:59:22 AM Central Daylight Time		10/16/2014 04:07:49 PM Central Daylight Time			10/17/2014 10:05:50 AM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valir.com	Dual (PACE)	08	20		1			H7114	001	0	2015	Oklahoma County		2		2			2								www.valir.com	www.valir.com									(888)898-2080		(405)609-3688		(888)898-8020		(405)609-3688										(711)-		(711)-		(711)-		(711)-												
H7114	002	0	1	20	08	H7114_002_0	1		1	10/16/2014	2015.03	10/16/2014 03:58:41 PM Central Daylight Time		10/16/2014 04:08:00 PM Central Daylight Time			10/17/2014 10:05:50 AM Central Daylight Time	VALIR PACE FOUNDATION	Valir PACE Foundation	www.valir.com	Medicare Only (PACE)	08	20		1			H7114	002	0	2015	Oklahoma County		2		2			2								www.valir.com	www.valir.com									(888)898-2080		(405)609-3688		(888)898-8020		(405)609-3688										(711)-		(711)-		(711)-		(711)-												
H7115	001	0	1	01	01	H7115_001_0	5		1	08/05/2014	2015.02	08/05/2014 04:39:16 PM Central Daylight Time	08/05/2014 05:27:02 PM Central Daylight Time	08/06/2014 12:27:47 PM Central Daylight Time			08/06/2014 05:17:11 PM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org	Memorial Hermann Advantage (HMO)	01	01		1			H7115	001	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		2		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764		(888)897-1337		(713)338-6764		(888)897-1337		(713)338-6764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7115	801	0	1	01	01	H7115_801_0	3		1	06/01/2014	2015.02	06/01/2014 08:06:09 AM Central Daylight Time	07/15/2014 04:44:02 PM Central Daylight Time				07/17/2014 10:56:54 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org	Memorial Hermann Advantage (HMO)	01	01		1			H7115	801	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764		(888)897-1337		(713)338-6764		(888)897-1337		(713)338-6764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011010010010111010001100000000	2		1					1
H7115	802	0	1	01	01	H7115_802_0	3		1	05/30/2014	2015.02	05/30/2014 05:33:43 PM Central Daylight Time	07/15/2014 04:41:17 PM Central Daylight Time				07/17/2014 10:56:54 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org	Memorial Hermann Advantage (HMO)	01	01		1			H7115	802	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764		(888)897-1337		(713)338-6764		(888)897-1337		(713)338-6764		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011010010010111010001100000000	2		1					1
H7115	803	0	1	01	01	H7115_803_0	3		1	05/30/2014	2015.02	05/30/2014 05:34:28 PM Central Daylight Time	07/15/2014 04:43:00 PM Central Daylight Time				07/17/2014 10:56:54 AM Central Daylight Time	MEMORIAL HERMANN HEALTH PLAN	Memorial Hermann Health Plan	healthplan.memorialhermann.org	Memorial Hermann Advantage (HMO)	01	01		1			H7115	803	0	2015	Texas Counties - Harris, Montgomery, Fort Bend		1		2			2							healthplan.memorialhermann.org	healthplan.memorialhermann.org	healthplan.memorialhermann.org			(713)338-6764		(888)897-1337		(713)338-6764										(711)-		(711)-		(711)-		(711)-										1	1	011100011010010100111010001100000000	2		1					1
H7149	001	0	1	01	01	H7149_001_0	4		1	08/03/2014	2015.01	08/03/2014 09:12:56 PM Central Daylight Time	08/04/2014 08:02:16 PM Central Daylight Time	08/01/2014 09:23:16 AM Central Daylight Time			08/06/2014 01:52:36 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver (HMO)	01	01		1			H7149	001	0	2015	Partial State of Nebraska		2	3800	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(800)707-7051		(800)707-7051		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7149	004	0	1	01	01	H7149_004_0	5		1	08/03/2014	2015.01	08/03/2014 09:13:04 PM Central Daylight Time	08/08/2014 09:48:16 AM Central Daylight Time	08/01/2014 09:23:27 AM Central Daylight Time			08/08/2014 02:30:49 PM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Total Care (HMO)	01	01		1			H7149	004	0	2015	Douglas and Sarpy Counties Nebraska		2	600	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(800)707-7051		(800)707-7051		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7149	005	0	1	01	01	H7149_005_0	4		1	07/02/2014	2015.01	07/02/2014 02:16:57 PM Central Daylight Time	08/04/2014 07:16:34 PM Central Daylight Time	08/01/2014 09:23:37 AM Central Daylight Time			08/06/2014 01:52:36 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Advantra Select Plus (HMO)	01	01		1			H7149	005	0	2015	Partial State of Nebraska		2	500	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(855)893-1444		(855)893-1444		(800)707-7051		(800)707-7051		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7149	801	0	1	01	01	H7149_801_0	1		1	04/25/2014	2015.01	04/25/2014 11:36:14 AM Central Daylight Time	05/29/2014 08:42:40 PM Central Daylight Time				05/31/2014 01:08:41 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/NoRx/Cyear (HMO)	01	01		1			H7149	801	0	2015	Partial State of Nebraska		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111000111001110000100	2		1					1
H7149	802	0	1	01	01	H7149_802_0	1		1	04/25/2014	2015.01	04/25/2014 11:44:35 AM Central Daylight Time	05/29/2014 08:51:32 PM Central Daylight Time				05/31/2014 01:08:41 AM Central Daylight Time	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Silver EmpGrp/Rx/Cyear (HMO)	01	01		1			H7149	802	0	2015	Partial State of Nebraska		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(800)707-7051		(800)707-7051		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111000111001110000100	2		1					1
H7172	001	0	1	48	05	H7172_001_0	2		1	06/26/2014	2015.01	06/26/2014 01:46:08 PM US Mountain Standard Time					06/30/2014 03:47:01 PM Mountain Daylight Time	AETNA BETTER HEALTH, INC. (OH)	Aetna Better Health of Ohio, MyCare Ohio	www.Aetnabetterhealth.com/Ohio	Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H7172	001	0	2015	Ohio		2		2			2							www.Aetnabetterhealth.com/Ohio	http://www.aetnamedicare.com/plan_choices/rx_find_presciptions.jsp	http://www.aetna.com/pharmacy-insurance/individuals-families/index.html	(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(855)364-0974		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7173	001	0	1	01	01	H7173_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 09:50:56 AM Pacific Daylight Time	08/05/2014 04:04:35 PM Pacific Daylight Time	08/05/2014 03:47:09 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	PEACH STATE HEALTH PLAN, INC.	Peach State Health Plan	http://advantage.pshpgeorgia.com	Peach State Health Plan Advantage (HMO SNP)	01	01		1			H7173	001	0	2015	Counties: 8 Metro Atlanta, 5 Columbus Region		2	306	2			1	3		1	2			http://advantage.pshpgeorgia.com	http://advantage.pshpgeorgia.com	http://www.pshpgeorgia.com/	(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(877)725-7748		(800)255-0056		(800)255-0056		(800)255-0056		(800)255-0056		(800)255-0056		(800)255-0056		(800)255-0056		(800)255-0056		2					2					2
H7187	003	0	1	01	01	H7187_003_0	2		1	05/30/2014	2015.01	05/30/2014 04:42:18 PM Central Daylight Time	08/04/2014 02:29:47 PM Central Daylight Time	07/31/2014 03:27:37 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H7187	003	0	2015	Richmond-Petersburg and Roanoke Metro areas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7187	009	0	1	01	01	H7187_009_0	2		1	05/30/2014	2015.01	05/30/2014 04:42:33 PM Central Daylight Time	08/04/2014 02:30:08 PM Central Daylight Time	07/31/2014 03:27:40 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 1 (HMO)	01	01		1			H7187	009	0	2015	Newport News, Norfolk and Portsmouth counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7187	010	0	1	01	01	H7187_010_0	2		1	05/30/2014	2015.01	05/30/2014 04:42:47 PM Central Daylight Time	08/04/2014 02:30:29 PM Central Daylight Time	07/31/2014 03:27:43 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H7187	010	0	2015	Richmond-Petersburg and Roanoke Metro areas		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7187	011	0	1	01	01	H7187_011_0	2		1	05/30/2014	2015.01	05/30/2014 04:44:49 PM Central Daylight Time	08/04/2014 02:30:51 PM Central Daylight Time	07/31/2014 03:27:46 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Plan 2 (HMO)	01	01		1			H7187	011	0	2015	Newport News, Norfolk and Portsmouth counties		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7195	001	0	1	20	08	H7195_001_0	1		1	05/22/2014	2015.01	05/22/2014 01:19:44 PM Central Daylight Time		05/16/2014 03:59:02 PM Central Daylight Time			05/22/2014 01:21:35 PM Central Daylight Time	NORTHLAND PACE PROGRAM	Northland PACE Senior Care Services	http://www.northlandpace.com	Northland PACE - Dual (PACE)	08	20		1			H7195	001	0	2015	Burleigh, Morton, and Stark Counties		2		2			2								n/a	http://www.pharmastarpbm.com/									(888)883-8959		(701)751-3050		(888)883-8959		(701)751-3050										(888)838-8959		(701)751-3050		(888)838-8959		(701)751-3050												
H7195	002	0	1	20	08	H7195_002_0	1		1	05/22/2014	2015.01	05/22/2014 01:20:15 PM Central Daylight Time		05/16/2014 04:06:46 PM Central Daylight Time			05/22/2014 01:21:35 PM Central Daylight Time	NORTHLAND PACE PROGRAM	Northland PACE Senior Care Services	http://www.northlandpace.com	Northland PACE - Medicare Only (PACE)	08	20		1			H7195	002	0	2015	Burleigh, Morton, and Stark Counties		2		2			2								n/a	http://www.pharmastarpbm.com/									(888)883-8959		(701)751-3050		(888)883-8959		(701)751-3050										(888)838-8959		(701)751-3050		(888)838-8959		(701)751-3050												
H7200	006	0	1	01	01	H7200_006_0	11	2	1	08/06/2014	2015.01	08/06/2014 11:01:27 AM Eastern Daylight Time	08/06/2014 04:06:11 PM Eastern Daylight Time	08/06/2014 04:08:26 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H7200	006	0	2015	Central Tennessee		2	5790	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H7200	007	0	1	01	01	H7200_007_0	12		1	08/06/2014	2015.01	08/06/2014 11:03:02 AM Eastern Daylight Time	08/06/2014 04:06:25 PM Eastern Daylight Time	08/06/2014 04:08:34 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	AMERIGROUP TENNESSEE, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H7200	007	0	2015	Central Tennessee		2	3455	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H7220	002	0	1	01	01	H7220_002_0	8		1	05/30/2014	2015.02	05/30/2014 04:56:40 PM Eastern Daylight Time	07/17/2014 03:35:12 PM Eastern Daylight Time				07/18/2014 05:34:00 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	IU Health Plans Medicare Select (HMO)	01	01		1			H7220	002	0	2015	State of Indiana - 33 counties		2	621	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(877)403-4178		(877)403-4178										(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333										2					2					2
H7220	003	0	1	01	01	H7220_003_0	9		1	08/05/2014	2015.02	08/05/2014 04:51:28 PM Eastern Daylight Time	08/05/2014 08:53:52 AM Eastern Daylight Time	08/04/2014 12:09:46 AM Eastern Daylight Time			08/05/2014 05:12:10 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	IU Health Plans Medicare Select Plus (HMO)	01	01		1			H7220	003	0	2015	State of Indiana - 33 counties		2	3206	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(877)403-4178		(877)403-4178		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2
H7220	004	0	1	02	01	H7220_004_0	9		1	08/05/2014	2015.02	08/05/2014 04:50:17 PM Eastern Daylight Time	08/05/2014 08:56:04 AM Eastern Daylight Time	08/04/2014 12:11:28 AM Eastern Daylight Time			08/05/2014 05:12:10 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	IU Health Plans Medicare Choice (HMO-POS)	01	02		1			H7220	004	0	2015	State of Indiana - 33 counties		2	5873	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(877)403-4178		(877)403-4178		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2
H7220	801	0	1	02	01	H7220_801_0	6		1	05/31/2014	2015.02	05/31/2014 09:48:31 AM Eastern Daylight Time	07/17/2014 05:46:52 PM Eastern Daylight Time				07/18/2014 05:34:00 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere Plus EGWP CY (HMO-POS)	01	02		1			H7220	801	0	2015	State of IN -  36 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2
H7220	802	0	1	02	01	H7220_802_0	7		1	07/02/2014	2015.02	07/02/2014 04:52:32 PM Eastern Daylight Time	07/17/2014 05:47:56 PM Eastern Daylight Time				07/18/2014 05:34:00 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere Plus EGWP NCY (HMO-POS)	01	02		1			H7220	802	0	2015	State of IN - 36 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2
H7220	804	0	1	01	01	H7220_804_0	7		1	07/02/2014	2015.02	07/02/2014 04:53:11 PM Eastern Daylight Time	07/17/2014 05:50:20 PM Eastern Daylight Time				07/18/2014 05:34:00 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere EGWP CY (HMO)	01	01		1			H7220	804	0	2015	State of IN - 36 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2
H7220	805	0	1	01	01	H7220_805_0	7		1	07/02/2014	2015.02	07/02/2014 04:53:49 PM Eastern Daylight Time	07/17/2014 05:49:14 PM Eastern Daylight Time				07/18/2014 05:34:00 PM Eastern Daylight Time	INDIANA UNIVERSITY HEALTH PLANS, INC.	Indiana University Health Plans - Medicare	www.iuhealthplansmedicare.org	Premiere EGWP NCY (HMO)	01	01		1			H7220	805	0	2015	State of IN- 36 Counties		1	643	2			2							www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	www.iuhealthplansmedicare.org	(800)455-9776		(317)963-9700		(800)455-9776		(317)963-9700		(855)266-0712		(855)266-0712		(855)266-0712		(855)266-0712		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		2					2					2
H7245	001	0	1	01	01	H7245_001_0	12		1	07/18/2014	2015.02	07/18/2014 09:08:22 AM Pacific Daylight Time	05/28/2014 08:05:43 PM Pacific Daylight Time	05/28/2014 08:05:43 PM Pacific Daylight Time			07/18/2014 02:38:40 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage (HMO)	01	01		1			H7245	001	0	2015	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7245	002	0	1	02	01	H7245_002_0	10		1	07/18/2014	2015.02	07/18/2014 09:10:50 AM Pacific Daylight Time	07/03/2014 09:13:42 AM Pacific Daylight Time	05/28/2014 08:05:43 PM Pacific Daylight Time			07/18/2014 02:38:40 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage (HMO-POS)	01	02		1			H7245	002	0	2015	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7245	003	0	1	01	01	H7245_003_0	7		1	07/18/2014	2015.02	07/18/2014 09:12:55 AM Pacific Daylight Time	05/28/2014 08:05:43 PM Pacific Daylight Time	05/28/2014 08:05:43 PM Pacific Daylight Time			07/18/2014 10:58:51 AM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage Plus (HMO)	01	01		1			H7245	003	0	2015	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7245	004	0	1	02	01	H7245_004_0	13		1	09/18/2014	2015.02	09/18/2014 09:12:25 AM Pacific Daylight Time	09/18/2014 03:29:25 PM Pacific Daylight Time	09/18/2014 03:29:25 PM Pacific Daylight Time			09/18/2014 03:40:58 PM Pacific Daylight Time	PREMERA BLUE CROSS	Premera Blue Cross Medicare Advantage	www.premera.com	Premera Blue Cross Medicare Advantage Plus (HMO-POS)	01	02		1			H7245	004	0	2015	King, Snohomish, Pierce, Thurston,Spokane counties		2		2			2							www.premera.com	www.premera.com	www.premera.com	(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(888)850-8526		(888)850-8526		(888)868-7767		(888)868-7767		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7301	002	0	1	04	01	H7301_002_0	7		1	08/12/2014	2015.01	08/12/2014 08:06:05 AM Central Daylight Time	08/05/2014 10:54:14 AM Central Daylight Time	08/01/2014 09:23:47 AM Central Daylight Time			08/12/2014 08:51:20 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra (PPO)	01	04		1			H7301	002	0	2015	Central and Northern Illinois		2	373	2			2							http://providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)893-1445		(855)893-1445		(800)707-9372		(800)707-9372		(855)893-1445		(855)893-1445		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7301	006	0	1	04	01	H7301_006_0	5		1	08/03/2014	2015.01	08/03/2014 01:27:47 PM Central Daylight Time	08/08/2014 09:29:42 AM Central Daylight Time	08/01/2014 09:23:57 AM Central Daylight Time			08/08/2014 02:39:14 PM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra Value (PPO)	01	04		1			H7301	006	0	2015	Illinois		2	1000	2			2							http://providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)893-1445		(855)893-1445		(800)707-9372		(800)707-9372		(855)893-1445		(855)893-1445		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7301	007	0	1	04	01	H7301_007_0	5		1	08/05/2014	2015.01	08/05/2014 08:55:26 PM Central Daylight Time	08/05/2014 11:04:28 AM Central Daylight Time	08/01/2014 09:24:08 AM Central Daylight Time			08/06/2014 02:18:12 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra Value (PPO)	01	04		1			H7301	007	0	2015	Illinois		2	1000	2			2							http://providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)893-1445		(855)893-1445		(855)893-1445		(855)893-1445		(855)893-1445		(855)893-1445		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7301	008	0	1	04	01	H7301_008_0	4		1	07/09/2014	2015.01	07/09/2014 06:04:36 PM Central Daylight Time	08/04/2014 07:18:16 PM Central Daylight Time	08/01/2014 09:28:15 AM Central Daylight Time			08/06/2014 02:18:12 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra Select Plus (PPO)	01	04		1			H7301	008	0	2015	Northern and Central Illinois		2	500	2			2							http://providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)893-1445		(855)893-1445		(855)893-1445		(855)893-1445		(855)893-1445		(855)893-1445		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7301	801	0	1	04	01	H7301_801_0	2		1	05/06/2014	2015.01	05/06/2014 11:36:15 AM Central Daylight Time	06/21/2014 10:21:39 PM Central Daylight Time				07/15/2014 08:17:18 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra MA Integrated Calendar (PPO)	01	04		1			H7301	801	0	2015	Central and Northern Illinois		1	12	2			2							http://providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)893-1445		(855)893-1445		(800)707-9372		(800)707-9372		(855)893-1445		(855)893-1445		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7301	803	0	1	04	01	H7301_803_0	2		1	05/30/2014	2015.01	05/30/2014 11:11:10 AM Central Daylight Time	06/21/2014 10:36:35 PM Central Daylight Time				07/15/2014 08:17:18 AM Central Daylight Time	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Coventry Health Care of Illinois, Inc.	www.chcillinoismedicare.com	Advantra MA Only (PPO)	01	04		1			H7301	803	0	2015	Central and Northern Illinois		1	12	2			2							http://providerdirectory.coventry-medicare.com	http://ilformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)784-4916		(866)784-4916		(855)893-1445		(855)893-1445										(711)-		(711)-		(711)-		(711)-										2					2					
H7306	001	0	1	04	01	H7306_001_0	13		1	08/04/2014	2015.01	08/04/2014 06:46:46 AM Central Daylight Time	08/07/2014 01:34:12 AM Central Daylight Time	08/06/2014 02:18:18 PM Central Daylight Time			08/07/2014 01:41:48 AM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Coventry Health Care	www.tx.chcadvantra.com	Advantra (PPO)	01	04		1			H7306	001	0	2015	West, Southwest, Central East , Southeast Area		2	140	2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693		(866)544-2965		(866)544-2965		(855)893-4693		(855)893-4693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7306	801	0	1	04	01	H7306_801_0	1		1	06/01/2014	2015.01	06/01/2014 12:06:45 PM Central Daylight Time	05/30/2014 10:18:56 PM Central Daylight Time				06/01/2014 12:07:13 PM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Coventry Health Care	www.tx.chcadvantra.com	Advantra (PPO)	01	04		1			H7306	801	0	2015	Texas Employer Group CYD No RX		1		2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100101110111011101000000	2		1					
H7306	803	0	1	04	01	H7306_803_0	1		1	06/01/2014	2015.01	06/01/2014 12:06:05 PM Central Daylight Time	05/30/2014 10:20:40 PM Central Daylight Time				06/01/2014 12:07:13 PM Central Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Coventry Health Care	www.tx.chcadvantra.com	Advantra (PPO)	01	04		1			H7306	803	0	2015	Texas - Employer Group Plan CYD with RX		1		2			2							http://www.ProviderDirectory.coventry-medicare.com	http://www.TXFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9570		(866)731-9570		(855)893-4693		(855)893-4693		(866)544-2965		(866)544-2965		(855)893-4693		(855)893-4693		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100101110111011101000000	2		1					
H7419	001	0	1	48	05	H7419_001_0	4		1	06/30/2014	2015.01	06/30/2014 09:08:27 AM Eastern Daylight Time					06/30/2014 09:33:49 AM Eastern Daylight Time	NETWORK HEALTH, LLC	Network Health Unify	www.NetworkHealthUnify.org	Network Health Unify (Medicare-Medicaid Plan)	05	48		1			H7419	001	0	2015	Worcester and Suffolk counties, Massachusetts		2	2000	1	1		2							www.Network-Health.org	www.NetworkHealthUnify.org	www.Network-Health.org	(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(855)393-3154		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		(888)391-5535		2					2					2
H7475	001	0	1	01	01	H7475_001_0	2	2	1	05/02/2014	2015.01	05/02/2014 11:27:48 AM Central Daylight Time	08/05/2014 04:18:04 PM Central Daylight Time	08/05/2014 04:18:17 PM Central Daylight Time			08/06/2014 08:30:18 AM Central Daylight Time	CARE WISCONSIN HEALTH PLAN, INC.	Care Wisconsin Health Plan, Inc.	www.carewisc.org/partnership	Partnership (HMO SNP)	01	01		1			H7475	001	0	2015	Columbia, Dodge, Jefferson and Sauk Counties		2	261	2			1	3		1	5			www.carewisc.org/partnership	www.carewisc.org/partnership	www.carewisc.org/partnership	(800)963-0035		(608)240-0035		(800)963-0035		(608)245-3075		(800)963-0035		(608)240-0035		(800)963-0035		(608)245-3075		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		1	2		2		1					1
H7501	001	0	1	20	08	H7501_001_0	1		1	05/29/2014	2015.01	05/29/2014 10:07:01 AM Pacific Daylight Time		05/28/2014 12:14:29 PM Pacific Daylight Time			05/29/2014 10:28:56 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org	CalOptima PACE (PACE)	08	20		1			H7501	001	0	2015	Orange County		2		2			2								www.caloptima.org	www.caloptima.org/home/providers/pharmacy.aspx									(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929												
H7501	002	0	1	20	08	H7501_002_0	1		1	05/29/2014	2015.01	05/29/2014 10:09:07 AM Pacific Daylight Time		05/28/2014 12:20:07 PM Pacific Daylight Time			05/29/2014 10:28:56 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima PACE	www.caloptima.org	CalOptima PACE (PACE)	08	20		1			H7501	002	0	2015	Orange County		2		2			2								www.caloptima.org	www.caloptima.org/home/providers/pharmacy.aspx									(855)785-2584		(714)468-1100		(855)785-2584		(714)468-1100										(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929												
H7542	001	0	1	48	05	H7542_001_0	3		1	09/12/2014	2015.01	09/12/2014 04:22:46 PM Eastern Daylight Time					09/12/2014 04:23:31 PM Eastern Daylight Time	ADVICARE, CORP.	Advicare	www.AdvicareHealth.com	Advicare, Corp. (Medicare-Medicaid Plan)	05	48		1			H7542	001	0	2015	South Carolina		2		2			2							www.AdvicareHealth.com	www.AdvicareHealth.com	www.AdvicareHealth.com	(888)781-4371		(864)616-6551		(888)781-4371		(864)616-6551		(888)781-4371		(864)616-6551		(888)781-4371		(864)616-6551		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		(888)357-7188		2					2					2
H7660	001	0	1	20	08	H7660_001_0	1		1	06/02/2014	2015.01	06/02/2014 05:29:42 PM Eastern Daylight Time		06/02/2014 02:03:11 PM Eastern Daylight Time			06/02/2014 06:03:49 PM Eastern Daylight Time	VIECARE BEAVER LLC DBA LIFE BEAVER COUNTY	LIFE Beaver and Lawrence Counties	http://www.lutheranseniorlife.org	LIFE Beaver-Dual (PACE)	08	20		1			H7660	001	0	2015	LIFE Beaver and Lawrence Counties		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)378-5400		(724)742-2226		(724)378-5400		(724)378-5400										(724)378-5400		(724)378-5400		(724)378-5400		(724)378-5400												
H7660	002	0	1	20	08	H7660_002_0	1		1	06/02/2014	2015.01	06/02/2014 05:29:59 PM Eastern Daylight Time		06/02/2014 02:07:49 PM Eastern Daylight Time			06/02/2014 06:03:49 PM Eastern Daylight Time	VIECARE BEAVER LLC DBA LIFE BEAVER COUNTY	LIFE Beaver and Lawrence Counties	www.LutheranSeniorLife.org	LIFE Beaver-Medicare only (PACE)	08	20		1			H7660	002	0	2015	LIFE Beaver and Lawrence Counties		2		2			2								www.lutheranseniorlife.org	www.lutheranseniorlife.org									(724)378-5400		(724)378-5400		(724)378-5400		(724)378-5400										(724)378-5400		(724)378-5400		(724)378-5400		(724)378-5400												
H7678	001	0	1	01	01	H7678_001_0	9	2	1	08/05/2014	2015.01	08/05/2014 08:44:59 AM Pacific Daylight Time	08/05/2014 12:04:00 PM Pacific Daylight Time	08/05/2014 09:40:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF TEXAS, INC.	Molina Healthcare of Texas, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H7678	001	0	2015	West, North, and Southern Texas		2		2			1	3		1	5			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)440-0012		(866)440-0012		(866)403-8293		(866)403-8293		(866)440-0012		(866)440-0012		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7680	001	0	1	01	01	H7680_001_0	9		1	08/05/2014	2015.01	08/05/2014 08:04:02 PM Eastern Daylight Time	08/06/2014 05:59:41 PM Eastern Daylight Time	08/06/2014 05:59:41 PM Eastern Daylight Time			08/06/2014 06:01:50 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Plus (HMO)	01	01		1			H7680	001	0	2015	North Texas		2	189	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		2					1					2
H7680	002	0	1	01	01	H7680_002_0	9		1	08/05/2014	2015.01	08/05/2014 08:07:44 PM Eastern Daylight Time	08/06/2014 05:59:41 PM Eastern Daylight Time	08/06/2014 05:59:41 PM Eastern Daylight Time			08/06/2014 06:06:21 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Plus (HMO)	01	01		1			H7680	002	0	2015	South Texas		2	900	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		2					1					2
H7680	801	0	1	01	01	H7680_801_0	5		1	05/28/2014	2015.01	05/28/2014 01:50:36 AM Eastern Daylight Time	07/19/2014 03:05:17 PM Eastern Daylight Time				07/19/2014 03:16:54 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Health Plan (HMO)	01	01		1			H7680	801	0	2015	National		1	1	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888										(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888										1	2		2		1					1
H7680	802	0	1	01	01	H7680_802_0	8		1	05/28/2014	2015.01	05/28/2014 01:48:34 AM Eastern Daylight Time	07/19/2014 03:05:16 PM Eastern Daylight Time				07/19/2014 03:17:53 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Health Plan (HMO)	01	01		1			H7680	802	0	2015	National		1	1	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		1	2		2		1					1
H7680	803	0	1	01	01	H7680_803_0	7		1	05/28/2014	2015.01	05/28/2014 01:49:19 AM Eastern Daylight Time	07/19/2014 03:05:16 PM Eastern Daylight Time				07/19/2014 03:18:20 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Health Plan (HMO)	01	01		1			H7680	803	0	2015	National		1	1	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		1	2		2		1					1
H7680	804	0	1	01	01	H7680_804_0	4		1	05/28/2014	2015.01	05/28/2014 06:52:18 PM Eastern Daylight Time	07/19/2014 03:05:16 PM Eastern Daylight Time				07/19/2014 03:19:10 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Health Plan (HMO)	01	01		1			H7680	804	0	2015	National		1	1	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888										(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888										1	2		2		1					1
H7680	805	0	1	01	01	H7680_805_0	6		1	05/28/2014	2015.01	05/28/2014 06:52:48 PM Eastern Daylight Time	07/19/2014 03:05:16 PM Eastern Daylight Time				07/19/2014 03:19:54 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Health Plan (HMO)	01	01		1			H7680	805	0	2015	National		1	1	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		1	2		2		1					1
H7680	806	0	1	01	01	H7680_806_0	6		1	05/28/2014	2015.01	05/28/2014 06:53:21 PM Eastern Daylight Time	07/19/2014 03:05:16 PM Eastern Daylight Time				07/19/2014 03:20:30 PM Eastern Daylight Time	UHS THP, INC.	UHS THP, Inc.	http://www.uhsinc.com/	Prominence Health Plan (HMO)	01	01		1			H7680	806	0	2015	National		1	1	1	1		2								http://www.uhsinc.com/	http://www.uhsinc.com/			(188)888-8888				(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		(188)888-8888		1	2		2		1					1
H7728	002	0	1	04	01	H7728_002_0	15		1	07/01/2014	2015.01	07/01/2014 12:12:09 PM Pacific Daylight Time	08/05/2014 11:53:25 PM Pacific Daylight Time	08/01/2014 02:31:17 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred Premier (PPO)	01	04		1			H7728	002	0	2015	Hillsborough and Rockingham Counties		2	586	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)304-1787		(855)304-1787		(800)797-6419		(800)797-6419		(855)304-1787		(855)304-1787		(800)797-6419		(800)797-6419		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7728	801	0	1	04	01	H7728_801_0	7		1	05/30/2014	2015.01	05/30/2014 03:11:00 PM Pacific Daylight Time	07/15/2014 03:59:39 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	801	0	2015	New Hampshire		1	1756	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H7728	802	0	1	04	01	H7728_802_0	6		1	05/30/2014	2015.01	05/30/2014 03:11:05 PM Pacific Daylight Time	07/15/2014 03:59:47 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	802	0	2015	New Hampshire		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H7728	803	0	1	04	01	H7728_803_0	6		1	05/30/2014	2015.01	05/30/2014 03:11:08 PM Pacific Daylight Time	07/15/2014 03:59:57 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Medicare Preferred (PPO)	01	04		1			H7728	803	0	2015	New Hampshire		1	50	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(855)320-6556		(855)320-6556		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H7787	001	0	1	04	01	H7787_001_0	3		1	05/22/2014	2015.02	05/22/2014 12:12:11 PM Central Daylight Time	08/04/2014 08:18:07 AM Central Daylight Time	07/31/2014 04:00:08 PM Central Daylight Time			08/05/2014 11:09:09 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (PPO)	01	04		1			H7787	001	0	2015	North Texas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7787	002	0	1	04	01	H7787_002_0	3		1	05/22/2014	2015.02	05/22/2014 12:12:30 PM Central Daylight Time	05/29/2014 10:25:22 AM Central Daylight Time				07/10/2014 10:39:35 PM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Advantage (PPO)	01	04		1			H7787	002	0	2015	North Texas		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098										(711)-		(711)-		(711)-		(711)-										2					2					
H7811	002	0	1	01	01	H7811_002_0	4		1	07/16/2014	2015.02	07/16/2014 03:10:56 PM Central Daylight Time	08/04/2014 08:18:36 AM Central Daylight Time	07/31/2014 04:00:17 PM Central Daylight Time			08/05/2014 11:09:09 AM Central Daylight Time	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Cigna-HealthSpring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H7811	002	0	2015	Gregg, Harrison, and Henderson counties		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(800)668-3813		(800)668-3813		(800)846-2098		(800)846-2098		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7844	001	0	1	48	05	H7844_001_0	4		1	10/16/2014	2015.01	10/16/2014 06:41:14 PM Pacific Daylight Time					10/16/2014 08:03:41 PM Pacific Daylight Time	MOLINA HEALTHCARE OF MICHIGAN, INC.	Molina Healthcare of Michigan	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H7844	001	0	2015	Wayne and Macomb County		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)735-5604		(855)735-5604		(855)701-4887		(855)701-4887		(855)735-5604		(855)735-5604		(855)701-4887		(855)701-4887		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7855	001	0	1	20	08	H7855_001_0	1		1	05/20/2014	2015.01	05/20/2014 10:13:27 AM Pacific Daylight Time		05/19/2014 12:20:55 PM Pacific Daylight Time			05/20/2014 10:17:15 AM Pacific Daylight Time	LOS ANGELES JEWISH HOME FOR THE AGING	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Dual (PACE)	08	20		1			H7855	001	0	2015	Brandman Centers for Senior Care-Dual		2		2			2								Nor applicable	www.pharmastarpbm.com									(855)744-8444	3033	(818)774-8444	3033	(855)774-8444		(818)774-8444										(818)774-3194		(818)774-3194		(818)774-3194		(818)774-3194												
H7855	002	0	1	20	08	H7855_002_0	1		1	05/20/2014	2015.01	05/20/2014 10:14:17 AM Pacific Daylight Time		05/19/2014 12:31:23 PM Pacific Daylight Time			05/20/2014 10:17:15 AM Pacific Daylight Time	LOS ANGELES JEWISH HOME FOR THE AGING	Brandman Centers for Senior Care	www.brandmanseniorcare.org	Brandman Centers for Senior Care-Medicare Only (PACE)	08	20		1			H7855	002	0	2015	Brandman Centers for Senior Care-Medicare Only		2		2			2								Nor applicable	www.pharmastarpbm.com									(855)744-8444	3033	(818)774-8444	3033	(855)774-8444		(818)774-8444										(818)774-3194		(818)774-3194		(818)774-3194		(818)774-3194												
H7885	001	0	1	48	05	H7885_001_0	4		1	07/25/2014	2015.01	07/25/2014 03:29:30 PM Pacific Daylight Time					07/25/2014 04:05:21 PM Pacific Daylight Time	SAN MATEO HEALTH COMMISSION	Health Plan of San Mateo	www.hpsm.org	CareAdvantage Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H7885	001	0	2015	San Mateo County		2	2427	2			2							www.hpsm.org	http://www.hpsm.org/members/careadvantage-2012/drug-coverage.aspx	http://www.hpsm.org/providers/provider-resources/pharmacy.aspx	(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(866)880-0606		(650)616-2174		(888)252-3153		(650)616-1500		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H7890	001	0	1	48	05	H7890_001_0	2		1	07/01/2014	2015.01	07/01/2014 10:24:29 AM Pacific Daylight Time					07/01/2014 10:25:55 AM Pacific Daylight Time	SANTA CLARA COUNTY HEALTH AUTHORITY	Santa Clara Family Health Plan Cal MediConnect	www.scfhp.com	Santa Clara Family Health Plan (Medicare-Medicaid Plan)	05	48		1			H7890	001	0	2015	Santa Clara County		2	1000	2			2							http://www.scfhp.com/for-members/find-a-doctor	http://www.scfhp.com/member/formulary.pdf	http://www.scfhp.com/member/prescriptions.aspx	(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(877)723-4795		(408)376-2000		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H7903	001	0	1	01	01	H7903_001_0	12		1	08/05/2014	2015.02	08/05/2014 05:11:11 PM Pacific Daylight Time	08/06/2014 07:49:48 AM Pacific Daylight Time	07/31/2014 04:38:28 PM Pacific Daylight Time			08/06/2014 02:22:46 PM Pacific Daylight Time	CLEARRIVER HEALTH	ClearRiver Health	www.clearriverhealth.com	Classic Plus Rx (HMO)	01	01		1			H7903	001	0	2015	Greater Chattanooga Metropolitan Area		2	2500	2			2							www.clearriverhealth.com	www.clearriverhealth.com	www.clearriverhealth.com	(877)512-3176		(253)345-5549		(877)512-3176		(253)345-5549		(877)512-3176		(253)345-5549		(877)512-3176		(253)345-5549		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7908	001	0	1	01	01	H7908_001_0	6		1	08/06/2014	2015.01	08/06/2014 11:06:53 AM Eastern Daylight Time	08/05/2014 06:04:36 PM Eastern Daylight Time	08/01/2014 10:28:36 AM Eastern Daylight Time			08/06/2014 12:01:24 PM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Select Plan (HMO)	01	01		1			H7908	001	0	2015	Clark County		2		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7908	801	0	1	01	01	H7908_801_0	2		1	05/24/2014	2015.01	05/24/2014 04:00:02 PM Eastern Daylight Time	06/01/2014 01:47:40 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan (HMO)	01	01		1			H7908	801	0	2015	Nevada		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-										2					1					1
H7908	802	0	1	01	01	H7908_802_0	2		1	05/24/2014	2015.01	05/24/2014 04:01:31 PM Eastern Daylight Time	06/01/2014 01:49:08 PM Eastern Daylight Time				06/02/2014 06:57:20 AM Eastern Daylight Time	AETNA HEALTH, INC. (PA)	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Plan w/Rx CY (HMO)	01	01		1			H7908	802	0	2015	Nevada		1		2			2							www.AetnaMedicareDocFind.com	www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com	(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(800)282-5366		(800)282-5366		(800)832-2640		(800)832-2640		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H7917	008	0	1	04	01	H7917_008_0	7		1	07/30/2014	2015.01	07/30/2014 02:54:39 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	008	0	2015	West Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	009	0	1	04	01	H7917_009_0	7		1	07/23/2014	2015.01	07/23/2014 10:42:45 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:13 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	009	0	2015	Middle Tennessee		2	1871	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	010	0	1	04	01	H7917_010_0	7		1	07/23/2014	2015.01	07/23/2014 10:48:17 AM Eastern Daylight Time	08/05/2014 04:02:13 PM Eastern Daylight Time	08/05/2014 04:02:13 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	010	0	2015	Southeast Tennessee		2	2146	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	011	0	1	04	01	H7917_011_0	7		1	07/23/2014	2015.01	07/23/2014 10:48:31 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Diamond (PPO)	01	04		1			H7917	011	0	2015	Northeast Tennessee		2	5335	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	012	0	1	04	01	H7917_012_0	8		1	07/23/2014	2015.01	07/23/2014 11:02:19 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	012	0	2015	West Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	013	0	1	04	01	H7917_013_0	8		1	07/23/2014	2015.01	07/23/2014 11:02:35 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	013	0	2015	Middle Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	014	0	1	04	01	H7917_014_0	8		1	07/23/2014	2015.01	07/23/2014 11:02:46 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	014	0	2015	Southeast Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	015	0	1	04	01	H7917_015_0	8		1	07/23/2014	2015.01	07/23/2014 11:03:02 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Ruby (PPO)	01	04		1			H7917	015	0	2015	Northeast Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	030	0	1	04	01	H7917_030_0	7		1	07/23/2014	2015.01	07/23/2014 11:06:23 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	030	0	2015	Southeast Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	031	0	1	04	01	H7917_031_0	7		1	07/23/2014	2015.01	07/23/2014 11:11:24 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Sapphire (PPO)	01	04		1			H7917	031	0	2015	Northeast Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	032	0	1	04	01	H7917_032_0	7		1	07/23/2014	2015.01	07/23/2014 11:12:26 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	032	0	2015	Middle Trennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	033	0	1	04	01	H7917_033_0	7		1	07/23/2014	2015.01	07/23/2014 11:12:46 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Garnet (PPO)	01	04		1			H7917	033	0	2015	West Tennessee		2	632	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H7917	801	0	1	04	01	H7917_801_0	1		1	05/28/2014	2015.01	05/28/2014 04:21:34 PM Eastern Daylight Time	06/01/2014 09:38:30 AM Eastern Daylight Time				06/01/2014 10:01:11 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	801	0	2015	22 County Region		1	500	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011110011110100010110011011100000100	2		1					
H7917	802	0	1	04	01	H7917_802_0	1		1	05/21/2014	2015.01	05/21/2014 09:16:36 AM Eastern Daylight Time	06/01/2014 09:38:30 AM Eastern Daylight Time				06/01/2014 10:01:11 AM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage Plus (PPO)	01	04		1			H7917	802	0	2015	22 County Region		1	500	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011110011110100010110011011100000100	2		1					
H7917	803	0	1	04	01	H7917_803_0	2		1	05/21/2014	2015.01	05/21/2014 09:21:06 AM Eastern Daylight Time	07/18/2014 02:53:29 PM Eastern Daylight Time				07/18/2014 03:01:34 PM Eastern Daylight Time	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	BlueCross BlueShield of Tennessee	bcbst-medicare.com	BlueAdvantage (PPO)	01	04		1			H7917	803	0	2015	22 County Region		1	500	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)831-2583		(800)831-2583		(800)292-5146		(800)292-5146										(711)-		(711)-		(711)-		(711)-										1	1	011110011110100010110011011100000100	2		1					
H7949	001	0	1	01	01	H7949_001_0	4		1	05/30/2014	2015.02	05/30/2014 04:31:22 PM Central Daylight Time	08/04/2014 02:31:35 PM Central Daylight Time	07/31/2014 03:27:50 PM Central Daylight Time			08/06/2014 01:49:44 PM Central Daylight Time	PACIFICARE OF NEVADA, INC.	SecureHorizons by UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete (HMO)	01	01		1			H7949	001	0	2015	Clark County		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(888)525-2086		(888)525-2086		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H7949	801	0	1	01	01	H7949_801_0	1		1	05/22/2014	2015.01	05/22/2014 09:17:52 AM Central Daylight Time	05/30/2014 05:17:07 PM Central Daylight Time				05/31/2014 12:07:05 PM Central Daylight Time	PACIFICARE OF NEVADA, INC.	SecureHorizons by UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H7949	801	0	2015	NV Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		1	111111111111111111111110111	1					1
H7949	803	0	1	01	01	H7949_803_0	1		1	05/22/2014	2015.01	05/22/2014 09:17:59 AM Central Daylight Time	05/30/2014 05:17:25 PM Central Daylight Time				05/31/2014 12:07:05 PM Central Daylight Time	PACIFICARE OF NEVADA, INC.	SecureHorizons by UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H7949	803	0	2015	NV Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H7949	804	0	1	01	01	H7949_804_0	1		1	05/22/2014	2015.01	05/22/2014 09:18:06 AM Central Daylight Time	05/30/2014 05:17:44 PM Central Daylight Time				05/31/2014 12:07:05 PM Central Daylight Time	PACIFICARE OF NEVADA, INC.	SecureHorizons by UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (HMO)	01	01		1			H7949	804	0	2015	NV Employer Sponsored Plan Service Area		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		1	111111111111111111111110111	1					1
H7960	001	0	1	01	01	H7960_001_0	8		1	08/05/2014	2015.01	08/05/2014 03:39:23 PM US Mountain Standard Time	08/06/2014 07:43:49 AM US Mountain Standard Time	08/06/2014 07:43:49 AM US Mountain Standard Time			08/06/2014 07:50:32 AM US Mountain Standard Time	HARBOR HEALTH PLAN, INC.	Harbor Advantage	www.harborhealthadvantage.com	Harbor Advantage (HMO)	01	01		1			H7960	001	0	2015	Wayne County		2	1300	2			2							www.harborhealthplan.com	www.harborhealthadvantage.com	www.harborhealthadvantage.com	(855)343-9243		(855)343-9243		(844)298-7800		(602)824-3900		(855)343-9243		(855)343-9243		(844)298-7800		(602)824-3900		(855)343-9243		(855)343-9243		(800)489-1472		(602)824-3909		(855)343-9243		(855)343-9243		(800)489-1472		(602)824-3909		2					2					2
H7971	001	0	1	04	01	H7971_001_0	10		1	07/11/2014	2015.02	07/11/2014 10:43:30 AM Eastern Daylight Time	08/06/2014 11:24:01 AM Eastern Daylight Time	08/06/2014 11:22:28 AM Eastern Daylight Time			08/06/2014 11:28:57 AM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue (PPO)	01	04		1			H7971	001	0	2015	Sussex County		2	8	2			2							http://directory.horizonblue.com	www.horizonblue.com/ma-drug-search	www.horizonblue.com/ma-pharmacy-search	(800)365-2223		(800)365-2223		(800)224-1234		(800)224-1234		(800)391-1906		(800)391-1906		(888)328-4542		(888)328-4542		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					
H7971	801	0	1	04	01	H7971_801_0	8		1	07/11/2014	2015.02	07/11/2014 11:01:38 AM Eastern Daylight Time	06/02/2014 02:04:34 PM Eastern Daylight Time				07/11/2014 01:48:56 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group (PPO)	01	04		1			H7971	801	0	2015	National		1	6500	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)328-4542		(888)328-4542										(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899										2					2					
H7971	802	0	1	04	01	H7971_802_0	7		1	07/11/2014	2015.02	07/11/2014 11:00:55 AM Eastern Daylight Time	06/02/2014 02:05:16 PM Eastern Daylight Time				07/11/2014 01:48:56 PM Eastern Daylight Time	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Horizon Blue Cross Blue Shield of New Jersey	www.horizonblue.com	Horizon Medicare Blue Group w/rx (PPO)	01	04		1			H7971	802	0	2015	National		1	6500	2			2							http://directory.horizonblue.com/	medicare.horizonblue.com/medicare-advantage-health-insurance-new-jersey-formulary-drug-search	medicare.horizonblue.com/medicare-advantage-health-insurance-plans-new-jersey-introduction	(800)365-2223		(800)365-2223		(888)328-4542		(888)328-4542		(800)391-1906		(800)391-1906		(888)328-4542		(888)328-4542		(800)855-2881		(800)855-2881		(800)852-7899		(800)852-7899		(711)-		(711)-		(800)852-7899		(800)852-7899		2					2					
H8016	001	0	1	48	05	H8016_001_0	2		1	06/30/2014	2015.01	06/30/2014 11:33:03 AM Pacific Daylight Time					06/30/2014 11:34:37 AM Pacific Daylight Time	ORANGE COUNTY HEALTH AUTHORITY	CalOptima	www.caloptima.org/CalMediConnect	CalOptima (Medicare-Medicaid Plan)	05	48		1			H8016	001	0	2015	Orange County, CA		2		2			2							www.caloptima.org	www.caloptima.org	http://www.caloptima.org/Home/Providers/Pharmacy.aspx	(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(855)705-8823		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		(800)735-2929		2					2					2
H8026	001	0	1	48	05	H8026_001_0	11		1	09/11/2014	2015.01	09/11/2014 03:20:41 PM Eastern Daylight Time					09/11/2014 03:22:26 PM Eastern Daylight Time	AETNA BETTER HEALTH OF MICHIGAN, INC.	Aetna Better Health Premier Plan	www.aetnabetterhealth.com/michigan	Aetna Better Health Premier Plan (Medicare-Medicaid Plan)	05	48		1			H8026	001	0	2015	Wayne, Macomb and Southwest Michigan Regions		2	1100	2			2							www.aetnabetterhealth.com/michigan	www.aetnabetterhealth.com/michigan	www.aetnabetterhealth.com/michigan	(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(855)676-5772		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8029	001	0	1	48	05	H8029_001_0	6		1	08/29/2014	2015.01	08/29/2014 01:35:33 PM Eastern Daylight Time					08/29/2014 01:36:31 PM Eastern Daylight Time	ELDERPLAN, INC.	Elderplan, Inc.	www.elderplan.org	Elderplan FIDA Total Care (Medicare-Medicaid Plan)	05	48		1			H8029	001	0	2015	Ki, Qu, Brx, NY, Ri, Wes, Suf, and Na		2		2			2							www.elderplan.org	www.elderplan.org	www.envisionrx.com	(855)462-3167		(718)921-7979		(866)695-8101		(866)695-8101		(844)860-6749		(718)921-7979		(866)695-8101		(866)695-8101		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8046	001	0	1	48	05	H8046_001_0	5		1	08/18/2014	2015.01	08/18/2014 10:31:54 AM Pacific Daylight Time					08/18/2014 10:59:29 AM Pacific Daylight Time	MOLINA HEALTHCARE OF ILLINOIS, INC.	Molina Healthcare of Illinois	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8046	001	0	2015	Central Illinois		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(877)901-8181		(877)901-8181		(877)901-8181		(877)901-8181		(877)901-8181		(877)901-8181		(877)901-8181		(877)901-8181		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8056	001	0	1	48	05	H8056_001_0	5		1	08/29/2014	2015.01	08/29/2014 01:57:52 PM Mountain Daylight Time					08/29/2014 02:20:05 PM Mountain Daylight Time	AETNA BETTER HEALTH, INC. (NY)	Aetna Better Health FIDA Plan	www.AetnaBetterHealth.com/ny	Aetna Better Health FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H8056	001	0	2015	Kings, Queens, New York, Suffolk and Nassau		2		2			2							www. AetnaBetterHealth.com/ny	http://www.aetnabetterhealth.com/ny/Providers/Providers.aspx	http://www.aetnabetterhealth.com/ny/Providers/Providers.aspx	(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(855)494-9945		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8064	002	0	1	04	01	H8064_002_0	6		1	08/05/2014	2015.01	08/05/2014 04:13:22 PM Pacific Daylight Time	08/06/2014 09:21:20 AM Pacific Daylight Time	08/06/2014 09:21:20 AM Pacific Daylight Time			08/06/2014 09:30:10 AM Pacific Daylight Time	FIRSTCAROLINACARE INSURANCE COMPANY	FirstCarolinaCare Insurance Company	www.firstmedicare.com	FirstMedicare Direct PPO Plus (PPO)	01	04		1			H8064	002	0	2015	South Central North Carolina		2	4513	2			2							www.firstmedicare.com	www.firstmedicare.com	www.firstmedicare.com	(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(888)350-7794		(888)350-7794		(877)279-1732		(877)279-1732		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8091	002	0	1	04	01	H8091_002_0	11		1	08/12/2014	2015.01	08/12/2014 09:42:58 AM Central Daylight Time	08/01/2014 09:53:27 AM Central Daylight Time	08/01/2014 08:40:51 AM Central Daylight Time			08/12/2014 09:56:27 AM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Medi-Pak Advantage Elite (PPO)	01	04		1			H8091	002	0	2015	Craighead, Cross, Greene, Lawrence and Poinsett		2	750	2			2							www.arkansasbluecross.com/providers/MedipakAdvantage.aspx	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)401-8808		(877)401-8808		(888)242-5017		(888)242-5017		(877)401-8808		(877)401-8808		(888)242-5017		(888)242-5017		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		2					2					
H8091	004	0	1	04	01	H8091_004_0	10		1	08/14/2014	2015.01	08/14/2014 03:38:22 PM Central Daylight Time	08/13/2014 04:25:16 PM Central Daylight Time	08/01/2014 08:40:09 AM Central Daylight Time			08/14/2014 03:47:21 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.abcbs.com	Medi-Pak Advantage Essential (PPO)	01	04		1			H8091	004	0	2015	Craighead, Cross, Greene, Lawrence and Poinsett		2	500	2			2							www.arkansasbluecross.com/providers/MedipakAdvantage.aspx	www.abcbs.com	http://www.arkansasbluecross.com	(877)401-8808		(877)401-8808		(888)242-5017		(888)242-5017		(877)401-8808		(877)401-8808		(888)242-5017		(888)242-5017		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		2					2					
H8096	001	0	1	20	08	H8096_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:06:58 PM Eastern Daylight Time		05/21/2014 04:01:11 PM Eastern Daylight Time			05/28/2014 01:08:48 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrahealth.com/pace-program	Centra PACE - Dual (PACE)	08	20		1			H8096	001	0	2015	Centra PACE - Lynchburg		2		2			2								http:\\www.centrahealth.com	www.centrahealth.com									(888)316-9540		(434)200-6516		(888)316-9540		(434)200-6516										(800)828-1140		(800)828-1140		(800)828-1140		(800)828-1140												
H8096	002	0	1	20	08	H8096_002_0	1		1	05/28/2014	2015.01	05/28/2014 01:07:26 PM Eastern Daylight Time		05/21/2014 04:09:01 PM Eastern Daylight Time			05/28/2014 01:08:48 PM Eastern Daylight Time	CENTRA HEALTH, INC.	Centra PACE	http://www.centrahealth.com/pace-program	Centra PACE - Medicare only (PACE)	08	20		1			H8096	002	0	2015	Centra PACE - Lynchburg		2		2			2								http:\\www.centrahealth.com	www.centrahealth.com									(888)316-9540		(434)200-6516		(888)316-9540		(434)200-6516										(800)828-1140		(800)828-1140		(800)828-1140		(800)828-1140												
H8130	001	0	1	01	01	H8130_001_0	11	2	1	07/29/2014	2015.01	07/29/2014 03:25:20 PM Pacific Daylight Time	08/05/2014 11:12:00 AM Pacific Daylight Time	08/05/2014 09:40:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF FLORIDA, INC.	Molina Healthcare of Florida	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H8130	001	0	2015	Panhandle, NE Florida, Tampa, and Central Florida		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)553-9494		(866)553-9494		(866)403-8293		(866)403-8293		(866)553-9494		(866)553-9494		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8133	001	0	1	01	01	H8133_001_0	15		1	08/06/2014	2015.01	08/06/2014 09:18:54 AM Central Daylight Time	08/06/2014 10:25:44 AM Central Daylight Time	08/06/2014 10:26:11 AM Central Daylight Time			08/06/2014 03:31:11 PM Central Daylight Time	GHS PROPERTY AND CASUALTY INSURANCE COMPANY	Blue Cross and Blue Shield of TX	www.mybluemapd.com	Blue Cross Medicare Advantage Basic (HMO)	01	01		1			H8133	001	0	2015	Houston		2	650	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8133	801	0	1	01	01	H8133_801_0	4		1	06/04/2014	2015.01	06/04/2014 09:33:23 AM Central Daylight Time	07/22/2014 03:14:38 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	GHS PROPERTY AND CASUALTY INSURANCE COMPANY	Blue Cross and Blue Shield of TX	www.mybluemapd.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	801	0	2015	Houston		1	5663	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H8133	803	0	1	01	01	H8133_803_0	4		1	06/02/2014	2015.01	06/02/2014 11:32:32 AM Central Daylight Time	07/22/2014 03:15:38 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	GHS PROPERTY AND CASUALTY INSURANCE COMPANY	Blue Cross and Blue Shield of TX	www.mybluemapd.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	803	0	2015	Houston		1	5663	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100000000000001100000001100000000	2		1					1
H8133	805	0	1	01	01	H8133_805_0	4		1	06/01/2014	2015.01	06/01/2014 05:40:41 PM Central Daylight Time	07/22/2014 03:16:40 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	GHS PROPERTY AND CASUALTY INSURANCE COMPANY	Blue Cross and Blue Shield of TX	www.hcsc.com	Blue Cross Medicare Advantage (HMO)	01	01		1			H8133	805	0	2015	Houston		1	5663	2			2								https://myprime.com	www.yourpartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100000000000001100000001100000000	2		1					1
H8145	003	0	1	09	04	H8145_003_0	4		1	07/14/2014	2015.02	07/14/2014 03:35:20 PM Eastern Daylight Time	08/03/2014 06:07:30 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-003 (PFFS)	04	09	1	1			H8145	003	0	2015	Select Counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	004	0	1	09	04	H8145_004_0	3		1	07/10/2014	2015.02	07/10/2014 01:56:08 PM Eastern Daylight Time	08/03/2014 06:07:05 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-004 (PFFS)	04	09	1	1			H8145	004	0	2015	Select counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	005	0	1	09	04	H8145_005_0	3		1	07/10/2014	2015.02	07/10/2014 01:41:22 PM Eastern Daylight Time	08/04/2014 10:09:01 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-005 (PFFS)	04	09	1	1			H8145	005	0	2015	Select Counties in Michigan		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	006	0	1	09	04	H8145_006_0	3		1	08/03/2014	2015.02	08/03/2014 02:17:42 PM Eastern Daylight Time	08/04/2014 10:21:07 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-006 (PFFS)	04	09	1	1			H8145	006	0	2015	Select Counties in Wisconsin		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	008	0	1	09	04	H8145_008_0	3		1	07/10/2014	2015.02	07/10/2014 05:19:45 PM Eastern Daylight Time	08/04/2014 10:03:46 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:15:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-008 (PFFS)	04	09	1	1			H8145	008	0	2015	Select Counties in Illinois		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	011	0	1	09	04	H8145_011_0	3		1	07/10/2014	2015.02	07/10/2014 04:25:54 PM Eastern Daylight Time	08/05/2014 09:42:49 AM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 11:43:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-011 (PFFS)	04	09	1	1			H8145	011	0	2015	Select Counties in Indiana		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	012	0	1	09	04	H8145_012_0	3		1	07/10/2014	2015.02	07/10/2014 01:34:36 PM Eastern Daylight Time	08/05/2014 09:43:09 AM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 11:43:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-012 (PFFS)	04	09	1	1			H8145	012	0	2015	Select Counties in Indiana		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	020	0	1	09	04	H8145_020_0	3		1	07/10/2014	2015.02	07/10/2014 02:39:55 PM Eastern Daylight Time	08/02/2014 08:06:46 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-020 (PFFS)	04	09	1	1			H8145	020	0	2015	Select Counties in Kentucky		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	021	0	1	09	04	H8145_021_0	4		1	07/10/2014	2015.02	07/10/2014 02:45:50 PM Eastern Daylight Time	08/02/2014 08:07:03 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-021 (PFFS)	04	09	1	1			H8145	021	0	2015	Select Counties in Kentucky		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	032	0	1	09	04	H8145_032_0	3		1	07/10/2014	2015.02	07/10/2014 04:32:17 PM Eastern Daylight Time	08/05/2014 09:52:16 AM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 11:43:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-032 (PFFS)	04	09	1	1			H8145	032	0	2015	Select Counties in Ohio		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	042	0	1	09	04	H8145_042_0	2		1	07/14/2014	2015.02	07/14/2014 01:19:00 PM Eastern Daylight Time	07/10/2014 03:05:08 PM Eastern Daylight Time				07/14/2014 03:33:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-042 (PFFS)	04	09	1	1			H8145	042	0	2015	Select Counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	050	0	1	09	04	H8145_050_0	2		1	07/10/2014	2015.02	07/10/2014 02:50:43 PM Eastern Daylight Time	07/09/2014 09:07:02 AM Eastern Daylight Time				07/14/2014 02:12:59 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-050 (PFFS)	04	09	1	1			H8145	050	0	2015	Select Counties in West Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	051	0	1	09	04	H8145_051_0	3		1	07/10/2014	2015.02	07/10/2014 02:56:36 PM Eastern Daylight Time	08/02/2014 07:58:53 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-051 (PFFS)	04	09	1	1			H8145	051	0	2015	Select Counties in West Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	052	0	1	09	04	H8145_052_0	3		1	07/10/2014	2015.02	07/10/2014 01:53:07 PM Eastern Daylight Time	08/03/2014 06:05:37 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-052 (PFFS)	04	09	1	1			H8145	052	0	2015	Select Counties in Pennsylvania		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	053	0	1	09	04	H8145_053_0	3		1	07/14/2014	2015.02	07/14/2014 01:24:10 PM Eastern Daylight Time	08/03/2014 06:05:59 PM Eastern Daylight Time	08/04/2014 05:04:18 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-053 (PFFS)	04	09	1	1			H8145	053	0	2015	Select Counties in Pennsylvania		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	055	0	1	09	04	H8145_055_0	2		1	07/14/2014	2015.02	07/14/2014 01:27:17 PM Eastern Daylight Time	07/10/2014 03:03:33 PM Eastern Daylight Time				07/14/2014 03:33:04 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-055 (PFFS)	04	09	1	1			H8145	055	0	2015	Select Counties in Pennsylvania		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	061	0	1	09	04	H8145_061_0	3		1	07/11/2014	2015.02	07/11/2014 01:44:29 PM Eastern Daylight Time	08/05/2014 07:42:22 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-061 (PFFS)	04	09	1	1			H8145	061	0	2015	Select Counties in Florida		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	063	0	1	09	04	H8145_063_0	5		1	08/06/2014	2015.01	08/06/2014 07:59:51 PM Eastern Daylight Time	08/05/2014 11:15:27 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-063 (PFFS)	04	09	1	1			H8145	063	0	2015	Select Counties in North Carolina		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	069	0	1	09	04	H8145_069_0	5		1	08/06/2014	2015.01	08/06/2014 08:08:12 PM Eastern Daylight Time	08/05/2014 09:37:21 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-069 (PFFS)	04	09	1	1			H8145	069	0	2015	Select Counties in South Carolina		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	075	0	1	09	04	H8145_075_0	5		1	07/24/2014	2015.02	07/24/2014 09:56:03 AM Eastern Daylight Time	08/02/2014 01:14:54 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-075 (PFFS)	04	09	1	1			H8145	075	0	2015	Select Counties in Alabama		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	078	0	1	09	04	H8145_078_0	3		1	07/10/2014	2015.02	07/10/2014 01:11:06 PM Eastern Daylight Time	08/04/2014 02:37:57 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-078 (PFFS)	04	09	1	1			H8145	078	0	2015	Select Counties in New Mexico		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	084	0	1	09	04	H8145_084_0	3		1	07/10/2014	2015.02	07/10/2014 01:12:52 PM Eastern Daylight Time	08/05/2014 02:08:02 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-084 (PFFS)	04	09	1	1			H8145	084	0	2015	Select Counties in Texas		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	087	0	1	09	04	H8145_087_0	4		1	07/24/2014	2015.02	07/24/2014 04:53:46 PM Eastern Daylight Time	08/02/2014 12:43:59 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-087 (PFFS)	04	09	1	1			H8145	087	0	2015	Select Counties in Mississippi		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	089	0	1	09	04	H8145_089_0	3		1	07/10/2014	2015.02	07/10/2014 02:25:30 PM Eastern Daylight Time	08/02/2014 12:03:20 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-089 (PFFS)	04	09	1	1			H8145	089	0	2015	Select Counties in MN, MT, SD, ND		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	091	0	1	09	04	H8145_091_0	5		1	07/24/2014	2015.02	07/24/2014 10:02:21 AM Eastern Daylight Time	08/02/2014 01:15:14 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-091 (PFFS)	04	09	1	1			H8145	091	0	2015	Select Counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	093	0	1	09	04	H8145_093_0	3		1	07/11/2014	2015.02	07/11/2014 09:03:12 AM Eastern Daylight Time	08/05/2014 02:15:25 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-093 (PFFS)	04	09	1	1			H8145	093	0	2015	Clackamas, Multnomah and Washington counties		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	097	0	1	09	04	H8145_097_0	5		1	07/11/2014	2015.02	07/11/2014 09:03:30 AM Eastern Daylight Time	07/11/2014 09:27:14 PM Eastern Daylight Time				07/14/2014 12:35:36 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-097 (PFFS)	04	09	1	1			H8145	097	0	2015	Select Counties in ID, MT, OR and WA		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	103	0	1	09	04	H8145_103_0	3		1	07/10/2014	2015.02	07/10/2014 01:22:19 PM Eastern Daylight Time	08/04/2014 05:06:28 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-103 (PFFS)	04	09	1	1			H8145	103	0	2015	Select Counties in Arizona		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	104	0	1	09	04	H8145_104_0	3		1	07/11/2014	2015.02	07/11/2014 09:03:49 AM Eastern Daylight Time	08/05/2014 02:14:58 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:45:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-104 (PFFS)	04	09	1	1			H8145	104	0	2015	Ada, Bonneville and Canyon counties		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	108	0	1	09	04	H8145_108_0	2		1	07/11/2014	2015.02	07/11/2014 10:40:39 AM Eastern Daylight Time	07/09/2014 04:00:09 PM Eastern Daylight Time				07/14/2014 12:46:54 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-108 (PFFS)	04	09	1	1			H8145	108	0	2015	Select Counties in Virginia		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	120	0	1	09	04	H8145_120_0	2		1	07/10/2014	2015.02	07/10/2014 01:18:12 PM Eastern Daylight Time	07/11/2014 07:40:46 PM Eastern Daylight Time				07/14/2014 12:53:53 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-120 (PFFS)	04	09	1	1			H8145	120	0	2015	Select Counties in AR, CO, KS, MO and OK		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	121	0	1	09	04	H8145_121_0	2		1	07/10/2014	2015.02	07/10/2014 01:49:48 PM Eastern Daylight Time	07/11/2014 03:35:01 PM Eastern Daylight Time				07/14/2014 02:49:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-121 (PFFS)	04	09	1	1			H8145	121	0	2015	Select Counties in Illinois and Michigan		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	122	0	1	09	04	H8145_122_0	3		1	08/04/2014	2015.02	08/04/2014 04:27:47 PM Eastern Daylight Time	08/04/2014 02:41:43 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-122 (PFFS)	04	09	1	1			H8145	122	0	2015	Select Counties in Arkansas, Kansas and Oklahoma		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	123	0	1	09	04	H8145_123_0	3		1	07/10/2014	2015.02	07/10/2014 01:16:02 PM Eastern Daylight Time	08/04/2014 02:39:10 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-123 (PFFS)	04	09	1	1			H8145	123	0	2015	Select Counties in Colorado		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	125	0	1	09	04	H8145_125_0	3		1	07/11/2014	2015.02	07/11/2014 09:02:24 AM Eastern Daylight Time	08/04/2014 02:42:30 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-125 (PFFS)	04	09	1	1			H8145	125	0	2015	Select Counties in Missouri		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	126	0	1	09	04	H8145_126_0	2		1	07/10/2014	2015.02	07/10/2014 01:17:32 PM Eastern Daylight Time	07/12/2014 02:04:45 PM Eastern Daylight Time				07/14/2014 12:28:07 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-126 (PFFS)	04	09	1	1			H8145	126	0	2015	Select Counties in Texas		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	127	0	1	09	04	H8145_127_0	3		1	07/10/2014	2015.02	07/10/2014 02:30:03 PM Eastern Daylight Time	08/02/2014 12:22:58 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 07:37:44 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-127 (PFFS)	04	09	1	1			H8145	127	0	2015	Select Counties in Iowa		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	154	0	1	09	04	H8145_154_0	3		1	07/11/2014	2015.02	07/11/2014 10:12:12 AM Eastern Daylight Time	08/04/2014 10:07:40 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-154 (PFFS)	04	09	1	1			H8145	154	0	2015	Select Counties in Michigan		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8145	155	0	1	09	04	H8145_155_0	3		1	07/10/2014	2015.02	07/10/2014 02:34:09 PM Eastern Daylight Time	07/10/2014 11:46:03 AM Eastern Daylight Time				07/14/2014 01:31:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-155 (PFFS)	04	09	1	1			H8145	155	0	2015	Select Counties in Iowa		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8145	162	0	1	09	04	H8145_162_0	2		1	07/10/2014	2015.02	07/10/2014 01:50:16 PM Eastern Daylight Time	07/10/2014 03:10:13 PM Eastern Daylight Time				07/14/2014 04:21:48 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Gold Choice H8145-162 (PFFS)	04	09	1	1			H8145	162	0	2015	Montgomery county		2		2			2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs/	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					2
H8146	001	0	1	01	01	H8146_001_0	7		1	08/05/2014	2015.01	08/05/2014 03:18:31 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	001	0	2015	Memphis Area		2	300	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	002	0	1	01	01	H8146_002_0	7		1	07/23/2014	2015.01	07/23/2014 11:22:35 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	002	0	2015	Rural Middle/West Area		2	300	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	003	0	1	01	01	H8146_003_0	7		1	07/23/2014	2015.01	07/23/2014 11:23:11 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	003	0	2015	Nashville Area		2	300	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	004	0	1	01	01	H8146_004_0	7		1	07/23/2014	2015.01	07/23/2014 11:23:41 AM Eastern Daylight Time	08/05/2014 04:02:14 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	004	0	2015	Rural East Area		2	300	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	005	0	1	01	01	H8146_005_0	7		1	07/23/2014	2015.01	07/23/2014 11:24:04 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	005	0	2015	Chattanooga Area		2	300	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	006	0	1	01	01	H8146_006_0	7		1	07/23/2014	2015.01	07/23/2014 11:24:23 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	006	0	2015	Knoxville Area		2	200	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	007	0	1	01	01	H8146_007_0	7		1	07/30/2014	2015.01	07/30/2014 02:28:08 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice (HMO)	01	01		1			H8146	007	0	2015	Tri-Cities Area		2		2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	008	0	1	01	01	H8146_008_0	7		1	08/05/2014	2015.01	08/05/2014 03:20:40 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	008	0	2015	Memphis Area		2	200	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	009	0	1	01	01	H8146_009_0	7		1	07/23/2014	2015.01	07/23/2014 11:28:24 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	009	0	2015	Rural Middle/West Area		2	100	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	010	0	1	01	01	H8146_010_0	7		1	07/23/2014	2015.01	07/23/2014 11:28:43 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	010	0	2015	Nashville Area		2	150	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	011	0	1	01	01	H8146_011_0	7		1	07/23/2014	2015.01	07/23/2014 11:29:04 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	011	0	2015	Rural East Area		2	100	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	012	0	1	01	01	H8146_012_0	7		1	07/23/2014	2015.01	07/23/2014 11:29:23 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	012	0	2015	Chattanooga Area		2	150	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	013	0	1	01	01	H8146_013_0	7		1	07/23/2014	2015.01	07/23/2014 11:29:36 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	013	0	2015	Knoxville Area		2	100	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8146	014	0	1	01	01	H8146_014_0	7		1	07/23/2014	2015.01	07/23/2014 11:29:52 AM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time	08/05/2014 04:02:15 PM Eastern Daylight Time			08/05/2014 04:20:52 PM Eastern Daylight Time	SECURITYCARE OF TENNESSEE, INC.	BlueChoice Tennessee	bcbst-medicare.com	BlueChoice Plus (HMO)	01	01		1			H8146	014	0	2015	Tri-Cities Area		2	100	2			2							bcbst-medicare.com	bcbst-medicare.com	bcbst-medicare.com	(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(800)317-2583		(800)317-2583		(888)337-9743		(888)337-9743		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8150	001	0	1	48	05	H8150_001_0	8		1	08/29/2014	2015.01	08/29/2014 09:53:12 AM Eastern Daylight Time					08/29/2014 09:57:42 AM Eastern Daylight Time	INTEGRA MLTC, INC	Integra FIDA Plan	www.integraplan.org	Integra FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H8150	001	0	2015	KI, QU, BRX, NY, RI, WES, SUF, NA		2	80	2			2								www.integraplan.org	www.integraplan.org	(855)661-0002		(855)661-0002				(855)800-4683		(855)661-0002		(855)661-0002		(855)800-4683		(855)800-4683		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H8170	001	0	1	01	01	H8170_001_0	8		1	08/07/2014	2015.01	08/07/2014 03:04:49 PM Eastern Daylight Time	08/07/2014 02:51:37 PM Eastern Daylight Time	08/04/2014 12:50:04 PM Eastern Daylight Time			08/07/2014 05:01:39 PM Eastern Daylight Time	AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.	America's 1st Choice of South Carolina	www.americas1stchoice.com	AFC Care Rx (HMO)	01	01		1			H8170	001	0	2015	Select Counties in SC		2	1	2			2							www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		2					2					2
H8170	002	0	1	01	01	H8170_002_0	7		1	08/05/2014	2015.01	08/05/2014 10:50:46 AM Eastern Daylight Time	08/04/2014 02:56:52 PM Eastern Daylight Time	08/04/2014 12:49:50 PM Eastern Daylight Time			08/05/2014 10:56:23 AM Eastern Daylight Time	AMERICA'S 1ST CHOICE OF SOUTH CAROLINA, INC.	America's 1st Choice of South Carolina	www.americas1stchoice.com	AFC Special Care Rx (HMO SNP)	01	01		1			H8170	002	0	2015	Select Counties in SC		2	1	2			1	4		1		00000000000000000010		www.americas1stchoice.com	www.americas1stchoice.com	www.americas1stchoice.com	(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(866)321-3947		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		(800)735-8583		2					2					2
H8189	001	0	1	01	01	H8189_001_0	6	2	1	08/05/2014	2015.01	08/05/2014 09:51:40 AM Pacific Daylight Time	08/05/2014 04:05:22 PM Pacific Daylight Time	08/05/2014 03:47:27 PM Pacific Daylight Time			08/06/2014 01:26:00 PM Pacific Daylight Time	MANAGED HEALTH SERVICES, WISCONSIN	Managed Health Services	advantage.mhswi.com	Managed Health Services Advantage (HMO SNP)	01	01		1			H8189	001	0	2015	27 Counties: Southeastern, Northeastern, Central		2	1550	2			1	3		1	3		1	advantage.mhswi.com	advantage.mhswi.com	advantage.mhswi.com	(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(877)935-8024		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		(800)947-3529		2					2					2
H8213	001	0	1	48	05	H8213_001_0	8		1	10/20/2014	2015.02	10/20/2014 09:30:17 AM Central Daylight Time					10/20/2014 09:45:20 AM Central Daylight Time	SELECT HEALTH OF SOUTH CAROLINA, INC.	FIRST CHOICE VIP CARE PLUS	http://firstchoicevipcareplus.com	First Choice VIP Care PLUS (Medicare-Medicaid Plan)	05	48		1			H8213	001	0	2015	All South Carolina Counties		2		2			2							http://firstchoicevipcareplus.com	http://firstchoicevipcareplus.com	http://firstchoicevipcareplus.com	(888)978-0862		(888)978-0862		(877)694-2314		(877)694-2314		(855)327-0511		(855)327-0511		(877)694-2314		(877)694-2314		(866)428-7583		(866)428-7583		(855)241-3649		(855)241-3649		(711)-		(711)-		(855)241-3649		(855)241-3649		2					2					2
H8237	001	0	1	01	01	H8237_001_0	5		1	08/06/2014	2015.01	08/06/2014 09:13:33 AM Central Daylight Time	08/06/2014 01:59:30 PM Central Daylight Time	08/06/2014 01:59:42 PM Central Daylight Time			08/06/2014 02:33:01 PM Central Daylight Time	INSURANCE COMPANY OF SCOTT AND WHITE	Vital Traditions	www.swhp.org	Vital Traditions (HMO)	01	01		1			H8237	001	0	2015	Central Texas		2		2			2							www.swhp.org	www.swhp.org	www.swhp.org	(888)423-7633		(888)423-7633		(877)845-3903		(877)845-3903		(888)423-7633		(888)423-7633		(877)845-3903		(877)845-3903		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		(800)735-2989		2					2					2
H8258	001	0	1	48	05	H8258_001_0	5		1	07/23/2014	2015.01	07/23/2014 03:22:53 PM Pacific Daylight Time					07/23/2014 03:25:29 PM Pacific Daylight Time	LOCAL INITIATIVE HEALTH AUTHORITY FOR L.A. COUNTY	L.A. Care Complete Choice	www.calmediconnectla.org	L.A Care Cal MediConnect Plan (Medicare-Medicaid Plan)	05	48		1			H8258	001	0	2015	Los Angeles County		2	300	2			2							www.calmediconnectla.org	www.calmediconnectla.org	www.calmediconnectla.org	(888)522-1298		(888)522-1298		(855)522-8243		(855)522-8243		(888)522-1298		(888)522-1298		(855)522-8243		(855)522-8243		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		(888)212-4460		2					2					2
H8266	001	0	1	01	01	H8266_001_0	5		1	08/06/2014	2015.01	08/06/2014 10:42:15 AM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time			08/06/2014 02:25:53 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Apollo - Constellation Health (HMO)	01	01		1			H8266	001	0	2015	Puerto Rico		2	3060	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2
H8266	002	0	1	01	01	H8266_002_0	5		1	08/06/2014	2015.01	08/06/2014 09:34:32 AM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time	08/06/2014 01:43:00 PM SA Western Standard Time			08/06/2014 02:32:14 PM SA Western Standard Time	CONSTELLATION HEALTH, LLC.	Constellation Health	www.constellationhealthpr.com	Orion Constellation Health (HMO)	01	01		1			H8266	002	0	2015	Orion Constellation Health		2	1250	2			2							www.constellationhealthpr.com	www.constellationhealthpr.com	www.constellationhealthpr.com	(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)714-0724		(787)304-4040		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		(866)805-7777		2					2					2
H8393	001	0	1	04	01	H8393_001_0	4		1	08/03/2014	2015.01	08/03/2014 09:13:25 PM Central Daylight Time	08/04/2014 08:05:28 PM Central Daylight Time	08/01/2014 09:28:45 AM Central Daylight Time			08/06/2014 02:00:46 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum (PPO)	01	04		1			H8393	001	0	2015	Partial State of Nebraska		2	3692	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(800)707-7052		(800)707-7052		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8393	801	0	1	04	01	H8393_801_0	3		1	04/25/2014	2015.01	04/25/2014 10:46:02 AM Central Daylight Time	06/27/2014 10:28:03 AM Central Daylight Time				07/21/2014 08:14:19 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/NoRx/Cyear (PPO)	01	04		1			H8393	801	0	2015	Partial State of Nebraska		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111000111001110000100	2		1					
H8393	802	0	1	04	01	H8393_802_0	4		1	04/25/2014	2015.01	04/25/2014 10:50:58 AM Central Daylight Time	06/27/2014 11:04:44 AM Central Daylight Time				07/21/2014 08:14:19 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	iowa-nebraska.chcadvantra.com	Coventry Advantra Platinum EmpGrp/Rx/Cyear (PPO)	01	04		1			H8393	802	0	2015	Partial State of Nebraska		1	0	2			2							ProviderDirectory.coventry-medicare.com	IANEFormulary.coventry-medicare.com	PharmacyLocator.coventry-medicare.com	(866)901-4692		(866)901-4692		(855)893-1444		(855)893-1444		(800)707-7052		(800)707-7052		(855)893-1444		(855)893-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111000111001110000100	2		1					
H8417	001	0	1	48	05	H8417_001_0	5		1	07/31/2014	2015.01	07/31/2014 09:37:40 PM Eastern Daylight Time					07/31/2014 09:50:36 PM Eastern Daylight Time	AMERIGROUP NEW YORK, LLC	HealthPlus Amerigroup	www.myamerigroup.com/medicare	HealthPlus Amerigroup FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H8417	001	0	2015	Counties: Kings, Queens, Bronx, New York, Richmond		2	2000	2			2							www.myamerigroup.com/medicare	www.myamerigroup/medicare.com	www.myamerigroup/medicare.com	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H8420	001	0	1	48	05	H8420_001_0	6		1	08/29/2014	2015.02	08/29/2014 09:01:01 AM Central Daylight Time					08/29/2014 09:32:37 AM Central Daylight Time	CENTERLIGHT HEALTHCARE, INC.	CenterLight Healthcare	centerlighthealthcare.org	CenterLight Healthcare FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H8420	001	0	2015	Ki, Qu, Brx, NY, Ri, Wes, Suf, Na		2		2			2							http://www.centerlighthealthcare.org/images/uploads/2013_CLHC_Direct_Provider_Directory_Complete_-_v	centerlighthealthcare.org	http://www.express-scripts.com/	(877)226-8500		(347)640-6110		(877)226-8500		(347)640-6110		(800)935-7195		(800)935-7195		(800)935-7195		(800)935-7195		(877)226-8500		(347)640-6110		(877)226-8500		(347)640-6110		(800)759-1089		(800)759-1089		(800)759-1089		(800)759-1089		2					2					2
H8424	001	0	1	20	08	H8424_001_0	1		1	05/19/2014	2015.01	05/19/2014 03:15:17 PM Central Daylight Time		05/16/2014 04:47:38 PM Central Daylight Time			05/19/2014 03:36:48 PM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	www.siouxlandpace.org	Siouxland PACE, INC (PACE)	08	20		1			H8424	001	0	2015	Siouxland PACE, INC		2		2			2								www.siouxlandpace.org	www.siouxlandpace.org									(888)722-3713		(712)224-7223	258	(888)722-3713		(712)224-7223	258									(800)383-4545		(712)224-7253		(800)383-4545		(712)224-7253												
H8424	002	0	1	20	08	H8424_002_0	2		1	05/19/2014	2015.01	05/19/2014 03:14:55 PM Central Daylight Time		05/16/2014 05:02:04 PM Central Daylight Time			05/21/2014 01:01:03 PM Central Daylight Time	SIOUXLAND PACE, INC.	SIOUXLAND PACE, INC.	www.siouxlandpace.org	Siouxland PACE, INC (PACE)	08	20		1			H8424	002	0	2015	Siouxland PACE, INC		2		2			2								www.siouxlandpace.org	www.siouxlandpace.org									(888)722-3713		(712)224-7223		(888)722-3713		(712)224-7223										(800)383-4545		(712)224-7253		(800)383-4545		(712)224-7253												
H8432	002	0	1	01	01	H8432_002_0	10	2	1	08/04/2014	2015.01	08/04/2014 09:48:52 AM Pacific Daylight Time	08/06/2014 11:28:16 AM Pacific Daylight Time	08/06/2014 01:06:38 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H8432	002	0	2015	Select Counties in Maine		2	289	2			1	3		1	5				www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2472		(855)310-2472		(800)797-6458		(800)797-6458		(855)310-2472		(855)310-2472		(800)797-6458		(800)797-6458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8432	003	0	1	01	01	H8432_003_0	12		1	07/25/2014	2015.01	07/25/2014 10:01:19 AM Pacific Daylight Time	08/05/2014 11:53:29 PM Pacific Daylight Time	08/01/2014 02:31:18 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H8432	003	0	2015	Select Counties in Maine		2	835	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(855)310-2472		(855)310-2472		(800)797-6458		(800)797-6458		(855)310-2472		(855)310-2472		(800)797-6458		(800)797-6458		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8432	801	0	1	01	01	H8432_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:39:55 AM Pacific Daylight Time	07/15/2014 01:24:56 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H8432	801	0	2015	Select Counties in Maine		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H8432	802	0	1	01	01	H8432_802_0	8		1	05/31/2014	2015.01	05/31/2014 11:40:04 AM Pacific Daylight Time	07/15/2014 01:25:01 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM HEALTH PLANS OF MAINE, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H8432	802	0	2015	Select Counties in Maine		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)249-9132		(855)249-9132		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H8452	001	0	1	48	05	H8452_001_0	6		1	07/24/2014	2015.01	07/24/2014 10:58:47 AM Eastern Daylight Time					07/24/2014 01:44:00 PM Eastern Daylight Time	CARESOURCE	CareSource MyCare Ohio	CareSource.com/MyCare	CareSource MyCare Ohio (Medicare-Medicaid Plan)	05	48		1			H8452	001	0	2015	12 Counties/3 Regions in the State of Ohio		2	25000	2			2							CareSource.com	CareSource.com/MyCare	www.caresource.com	(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(855)475-3163		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		(800)750-0750		2					2					2
H8468	001	0	1	07	02	H8468_001_0	2		2	05/31/2014	2015.02	05/31/2014 07:33:03 PM Eastern Daylight Time			06/03/2014 02:21:26 PM Eastern Daylight Time		06/03/2014 07:22:10 PM Eastern Daylight Time	GEISINGER INDEMNITY INSURANCE COMPANY	Geisinger Gold	www.GeisingerGold.com	Geisinger Gold Reserve (MSA)	02	07	2	1			H8468	001	0	2015	Pennsylvania		2		2			2							www.GeisingerGold.com			(800)498-9731		(570)271-8771		(800)514-0138		(800)514-0138										(711)-		(711)-		(711)-		(711)-																				
H8490	001	0	1	48	05	H8490_001_0	5		1	07/31/2014	2015.01	07/31/2014 04:32:30 PM Eastern Daylight Time					08/01/2014 02:21:35 PM Eastern Daylight Time	VNS CHOICE	VNSNY CHOICE Medicare	www.vnsnychoice.org	VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)	05	48		1			H8490	001	0	2015	Ki, Qu, Brx, NY, Ri, Wes, Suf and Na		2	9000	2			2								www.vnsnychoice.org	www.vnsnychoice.org	(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(866)783-1444		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8506	001	0	1	01	01	H8506_001_0	6		1	07/15/2014	2015.01	07/15/2014 01:58:06 PM Pacific Daylight Time	08/05/2014 09:22:39 AM Pacific Daylight Time	07/31/2014 01:46:02 PM Pacific Daylight Time			08/05/2014 12:03:21 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	Moda Health Plan, Inc.	www.modahealth.com/medicare	Moda Health HMO (HMO)	01	01		1			H8506	001	0	2015	Eastern Oregon		2	300	2			2							www.modahealth.com/medicare	www.modahealth.com/medicare	www.modahealth.com/medicare	(877)299-9062		(503)265-4762		(888)217-2375		(503)265-2975		(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8552	020	0	1	04	01	H8552_020_0	15		1	07/17/2014	2015.01	07/17/2014 02:47:13 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H8552	020	0	2015	Orange County		2	3352	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8552	021	0	1	04	01	H8552_021_0	14		1	07/17/2014	2015.01	07/17/2014 02:47:27 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time			08/06/2014 04:01:39 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H8552	021	0	2015	Riverside County		2	1017	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8552	022	0	1	04	01	H8552_022_0	15		1	07/17/2014	2015.01	07/17/2014 02:47:44 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H8552	022	0	2015	San Diego County		2	2253	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8552	024	0	1	04	01	H8552_024_0	16		1	07/17/2014	2015.01	07/17/2014 02:47:58 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time	08/06/2014 03:26:44 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H8552	024	0	2015	San Francisco County		2	500	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8552	027	0	1	04	01	H8552_027_0	15		1	07/17/2014	2015.01	07/17/2014 02:48:11 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time	08/06/2014 03:26:43 PM Pacific Daylight Time			08/07/2014 09:06:23 AM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred Standard (PPO)	01	04		1			H8552	027	0	2015	Madera County		2	111	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(877)811-3107		(877)811-3107		(800)797-6438		(800)797-6438		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8552	801	0	1	04	01	H8552_801_0	5		1	05/30/2014	2015.01	05/30/2014 03:11:16 PM Pacific Daylight Time	07/15/2014 04:00:17 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	801	0	2015	California		1	2573	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H8552	802	0	1	04	01	H8552_802_0	4		1	05/30/2014	2015.01	05/30/2014 03:11:19 PM Pacific Daylight Time	07/15/2014 04:00:26 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	802	0	2015	California		1	50	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H8552	803	0	1	04	01	H8552_803_0	4		1	05/30/2014	2015.01	05/30/2014 03:11:22 PM Pacific Daylight Time	07/15/2014 04:00:36 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Anthem Blue Cross Life and Health Insurance Co.	www.anthem.com/ca/Medicare	Anthem Medicare Preferred (PPO)	01	04		1			H8552	803	0	2015	California		1	50	2			2							www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	www.anthem.com/ca/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H8554	001	0	1	01	01	H8554_001_0	9		1	09/11/2014	2015.01	09/11/2014 08:43:09 AM US Mountain Standard Time	09/11/2014 09:43:29 AM US Mountain Standard Time	09/11/2014 10:02:23 AM US Mountain Standard Time			09/11/2014 10:03:04 AM US Mountain Standard Time	VALLEY BAPTIST INSURANCE COMPANY	Valley Baptist Health Plans	www.valleybaptistadvantage.com	Valley Baptist Advantage (HMO)	01	01		1			H8554	001	0	2015	Cameron, Hidalgo, and Willacy Counties, TX		2	1300	2			2							www.valleybaptistadvantage.com	www.valleybaptistadvantage.com	www.valleybaptistadvantage.com	(855)805-4152		(855)805-4152		(844)298-7900		(855)805-4152		(855)805-4152		(855)805-4152		(844)298-7900		(855)805-4152		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8578	001	0	1	01	01	H8578_001_0	5		1	07/21/2014	2015.01	07/21/2014 09:40:48 AM Eastern Daylight Time	08/01/2014 03:32:52 PM Eastern Daylight Time	08/06/2014 02:00:13 PM Eastern Daylight Time			08/06/2014 04:30:13 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Premium (HMO)	01	01		1			H8578	001	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	3497	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	003	0	1	01	01	H8578_003_0	4		1	07/21/2014	2015.01	07/21/2014 09:40:21 AM Eastern Daylight Time	06/08/2014 12:00:45 PM Eastern Daylight Time				07/21/2014 01:54:04 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Premium No Rx (HMO)	01	01		1			H8578	003	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	207	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370										2					2					2
H8578	004	0	1	01	01	H8578_004_0	5		1	07/21/2014	2015.01	07/21/2014 09:43:38 AM Eastern Daylight Time	08/01/2014 03:34:54 PM Eastern Daylight Time	08/06/2014 02:01:01 PM Eastern Daylight Time			08/06/2014 04:30:13 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Plus (HMO)	01	01		1			H8578	004	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	2768	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	007	0	1	01	01	H8578_007_0	5		1	07/21/2014	2015.01	07/21/2014 09:45:28 AM Eastern Daylight Time	08/06/2014 11:30:08 AM Eastern Daylight Time	08/06/2014 02:01:49 PM Eastern Daylight Time			08/06/2014 04:30:13 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Basic (HMO)	01	01		1			H8578	007	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	1483	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	009	0	1	01	01	H8578_009_0	4		1	07/21/2014	2015.01	07/21/2014 09:47:36 AM Eastern Daylight Time	06/08/2014 12:01:20 PM Eastern Daylight Time				07/21/2014 01:54:04 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Basic No Rx (HMO)	01	01		1			H8578	009	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	204	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370										2					2					2
H8578	010	0	1	02	01	H8578_010_0	6		1	09/18/2014	2015.01	09/18/2014 04:27:08 PM Eastern Daylight Time	08/01/2014 03:39:27 PM Eastern Daylight Time	08/06/2014 02:02:11 PM Eastern Daylight Time			09/22/2014 03:44:28 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Freedom (HMO-POS)	01	02		1			H8578	010	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	349	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	012	0	1	01	01	H8578_012_0	5		1	07/21/2014	2015.01	07/21/2014 09:52:00 AM Eastern Daylight Time	08/01/2014 03:40:15 PM Eastern Daylight Time	08/06/2014 02:02:36 PM Eastern Daylight Time			08/06/2014 04:30:13 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Value (HMO)	01	01		1			H8578	012	0	2015	Hampden, Hampshire, Franklin, Berkshire Counties		2	7	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	013	0	1	01	01	H8578_013_0	4		1	08/05/2014	2015.01	08/05/2014 02:46:47 PM Eastern Daylight Time	08/04/2014 10:50:45 AM Eastern Daylight Time	08/06/2014 02:03:02 PM Eastern Daylight Time			08/06/2014 04:30:13 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Premier 1 (HMO)	01	01		1			H8578	013	0	2015	Hartford County		2	388	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	014	0	1	01	01	H8578_014_0	4		1	07/21/2014	2015.01	07/21/2014 09:55:12 AM Eastern Daylight Time	08/04/2014 10:52:25 AM Eastern Daylight Time	08/06/2014 02:03:30 PM Eastern Daylight Time			08/06/2014 04:30:13 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Premier 2 (HMO)	01	01		1			H8578	014	0	2015	Hartford County		2	345	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	015	0	1	02	01	H8578_015_0	6		1	08/29/2014	2015.01	08/29/2014 03:59:47 PM Eastern Daylight Time	08/04/2014 10:53:52 AM Eastern Daylight Time	08/06/2014 02:04:08 PM Eastern Daylight Time			09/22/2014 03:44:28 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Premier 3 (HMO-POS)	01	02		1			H8578	015	0	2015	Hartford County		2	129	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		2					2					2
H8578	801	0	1	02	01	H8578_801_0	3		1	05/23/2014	2015.01	05/23/2014 05:30:41 PM Eastern Daylight Time	06/08/2014 12:01:43 PM Eastern Daylight Time				06/08/2014 12:09:44 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Employer Group RX (HMO-POS)	01	02		1			H8578	801	0	2015	United States		1	1000	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		1	1	000100011000100100100111011110000000	2		1	1	000100011000100100100111011000000000	2		1
H8578	802	0	1	02	01	H8578_802_0	2		1	05/23/2014	2015.01	05/23/2014 05:31:34 PM Eastern Daylight Time	05/31/2014 10:04:46 PM Eastern Daylight Time				05/31/2014 10:24:16 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Employer Group Calendar (HMO-POS)	01	02		1			H8578	802	0	2015	United States		1	5	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010										(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370										1	1	000100011000100100100111011110000000	2		1	1	000100011000100100100111011110000000	2		1
H8578	803	0	1	02	01	H8578_803_0	2		1	05/23/2014	2015.01	05/23/2014 05:35:30 PM Eastern Daylight Time	05/31/2014 10:04:46 PM Eastern Daylight Time				05/31/2014 10:24:16 PM Eastern Daylight Time	HEALTH NEW ENGLAND, INC.	HNE Medicare Advantage Plans	www.hne.com/medicare	HNE Medicare Employer Group Non-Calendar (HMO-POS)	01	02		1			H8578	803	0	2015	United States		1	5	2			2							www.hne.com/medicare	www.hne.com/medicare	www.hne.com/medicare	(877)443-3314		(413)787-0010		(877)443-3314		(413)787-0010		(800)546-5677		(800)546-5677		(800)546-5677		(800)546-5677		(800)439-2370		(800)439-2370		(800)439-2370		(800)439-2370		(866)706-4757		(866)706-4757		(866)706-4757		(866)706-4757		1	1	000100011000100100100111011110000000	2		1	1	000100011000100100100111011110000000	2		1
H8604	007	1	1	04	01	H8604_007_1	5		1	07/22/2014	2015.01	07/22/2014 11:56:16 AM Central Daylight Time	08/05/2014 04:23:25 PM Central Daylight Time	08/06/2014 10:06:21 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Option II (PPO)	01	04		1			H8604	007	1	2015	East Ohio, WV	Eastern Ohio, Northern WV	2	600	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					
H8604	007	2	1	04	01	H8604_007_2	5		1	07/22/2014	2015.01	07/22/2014 11:45:38 AM Central Daylight Time	08/05/2014 04:23:46 PM Central Daylight Time	08/06/2014 10:06:34 AM Central Daylight Time			08/06/2014 10:30:59 AM Central Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Option II (PPO)	01	04		1			H8604	007	2	2015	East Ohio, WV	Southeastern Ohio, Central and Southern WV	2	100	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		2					2					
H8604	008	1	1	04	01	H8604_008_1	4		1	07/22/2014	2015.01	07/22/2014 11:45:54 AM Central Daylight Time	06/03/2014 10:09:00 AM Central Daylight Time				07/22/2014 12:09:07 PM Central Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Option I (PPO)	01	04		1			H8604	008	1	2015	East Ohio, WV	Eastern Ohio, Northern WV	2	600	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										2					2					
H8604	008	2	1	04	01	H8604_008_2	4		1	07/22/2014	2015.01	07/22/2014 11:46:12 AM Central Daylight Time	06/03/2014 10:09:50 AM Central Daylight Time				07/22/2014 12:09:07 PM Central Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Option I (PPO)	01	04		1			H8604	008	2	2015	East Ohio, WV	Southeastern Ohio, Central and Southern WV	2	100	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										2					2					
H8604	801	0	1	04	01	H8604_801_0	3		1	05/29/2014	2015.01	05/29/2014 05:27:46 PM Central Daylight Time	06/02/2014 03:29:29 PM Central Daylight Time				07/21/2014 05:57:47 PM Central Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Employer (PPO)	01	04		1			H8604	801	0	2015	Eastern Ohio and Northern West Virginia		1	132	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919		1	1	011111111111111110111111011111000010	1	011111111111110111111010001	1					
H8604	802	0	1	04	01	H8604_802_0	3		1	05/29/2014	2015.01	05/29/2014 05:28:41 PM Central Daylight Time	06/02/2014 03:29:51 PM Central Daylight Time				07/21/2014 05:57:47 PM Central Daylight Time	THP INSURANCE COMPANY	Health Plan SecureChoice	www.healthplan.org	SecureChoice - Employer (PPO)	01	04		1			H8604	802	0	2015	Eastern Ohio and Northern West Virginia		1	14	2			2							www.healthplan.org	www.healthplan.org	www.healthplan.org	(877)847-7907		(740)695-7907		(877)847-7915		(740)695-7915										(800)622-3925		(740)695-7919		(800)622-3925		(740)695-7919										1	1	011111111111111110111111011111000010	1	011111111111110111111010001	1					
H8634	001	0	1	04	01	H8634_001_0	10		1	08/05/2014	2015.01	08/05/2014 10:27:44 AM Central Daylight Time	08/05/2014 03:58:18 PM Central Daylight Time	08/05/2014 09:56:12 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	001	0	2015	Oklahoma City Metro Area		2	504	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8634	002	0	1	04	01	H8634_002_0	12		1	08/05/2014	2015.01	08/05/2014 10:27:31 AM Central Daylight Time	08/05/2014 04:00:04 PM Central Daylight Time	08/05/2014 09:57:46 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	002	0	2015	Benalillo, Sandoval Torrance and Valencia counties		2	770	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8634	003	0	1	04	01	H8634_003_0	14		1	07/23/2014	2015.01	07/23/2014 11:25:51 AM Central Daylight Time	08/05/2014 04:02:20 PM Central Daylight Time	08/05/2014 09:59:32 AM Central Daylight Time			08/06/2014 08:12:43 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Plus (PPO)	01	04		1			H8634	003	0	2015	Chicago Metro Area		2	376	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8634	004	0	1	04	01	H8634_004_0	15		1	07/21/2014	2015.01	07/21/2014 09:26:19 AM Central Daylight Time	08/05/2014 04:03:40 PM Central Daylight Time	08/05/2014 10:01:20 AM Central Daylight Time			08/06/2014 08:12:43 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H8634	004	0	2015	Chicago Metro Area		2	94	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8634	005	0	1	04	01	H8634_005_0	13		1	08/05/2014	2015.01	08/05/2014 10:26:47 AM Central Daylight Time	08/05/2014 04:01:22 PM Central Daylight Time	08/05/2014 10:03:50 AM Central Daylight Time			08/06/2014 08:35:23 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage Choice Premier (PPO)	01	04		1			H8634	005	0	2015	PPO Counties Outside of ABQ		2	83	2			2							www.mybluemapd.com	www.mybluemapd.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8634	801	0	1	04	01	H8634_801_0	4		1	06/02/2014	2015.01	06/02/2014 11:38:01 AM Central Daylight Time	07/22/2014 02:53:40 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	801	0	2015	State of New Mexico		1	2678	2			2							www.mybluemapd.com	https://myprime.com	www.mybluepartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H8634	803	0	1	04	01	H8634_803_0	4		1	06/02/2014	2015.01	06/02/2014 10:41:51 AM Central Daylight Time	07/22/2014 02:55:08 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	803	0	2015	State of New Mexico		1	2678	2			2							www.mybluemapd.com	https://myprime.com	www.mybluepartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H8634	805	0	1	04	01	H8634_805_0	4		1	06/02/2014	2015.01	06/02/2014 11:30:30 AM Central Daylight Time	07/22/2014 02:56:42 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	805	0	2015	State of New Mexico		1	2678	2			2							www.mybluemapd.com	https://myprime.com	www.mybluepartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100011100000000110000001100000000	2		1					
H8634	807	0	1	04	01	H8634_807_0	4		1	06/02/2014	2015.01	06/02/2014 10:58:51 AM Central Daylight Time	07/22/2014 03:00:18 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	807	0	2015	State of Oklahoma		1	3391	2			2							www.mybluemapd.com	https://myprime.com	www.mybluepartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H8634	809	0	1	04	01	H8634_809_0	4		1	06/02/2014	2015.01	06/02/2014 10:59:52 AM Central Daylight Time	07/22/2014 03:02:02 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	809	0	2015	State of Oklahoma		1	3391	2			2							www.mybluemapd.com	https://myprime.com	www.mybluepartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H8634	811	0	1	04	01	H8634_811_0	4		1	06/02/2014	2015.01	06/02/2014 11:01:00 AM Central Daylight Time	07/22/2014 03:03:34 PM Central Daylight Time				07/23/2014 11:31:40 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	BlueCross Medicare Advantage (PPO)	01	04		1			H8634	811	0	2015	State of Oklahoma		1	3391	2			2							www.mybluemapd.com	https://myprime.com	www.mybluepartd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100011100000000110000001100000000	2		1					
H8634	813	0	1	04	01	H8634_813_0	4		1	06/02/2014	2015.01	06/02/2014 11:59:53 AM Central Daylight Time	07/22/2014 03:06:40 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	813	0	2015	State of Illinois		1	4719	2			2							www.mybluemapd.com	https://myprime.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H8634	815	0	1	04	01	H8634_815_0	4		1	06/02/2014	2015.01	06/02/2014 12:02:03 PM Central Daylight Time	07/22/2014 03:08:14 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	815	0	2015	State of Illinois		1	4719	2			2							www.mybluemapd.com	https://myprime.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011100000000110000001100000000	2		1					
H8634	817	0	1	04	01	H8634_817_0	4		1	06/02/2014	2015.01	06/02/2014 12:04:29 PM Central Daylight Time	07/22/2014 03:09:48 PM Central Daylight Time				07/23/2014 09:20:44 AM Central Daylight Time	HEALTH CARE SERVICE CORPORATION	Blue Cross and Blue Shield of IL, NM, OK	www.mybluemapd.com	Blue Cross Medicare Advantage (PPO)	01	04		1			H8634	817	0	2015	State of Illinois		1	4719	2			2							www.mybluemapd.com	https://myprime.com	www.mybluemapd.com	(877)774-8592		(877)774-8592		(877)583-8129		(877)583-8129										(711)-		(711)-		(711)-		(711)-										1	1	011100011100000000110000001100000000	2		1					
H8649	003	0	1	01	01	H8649_003_0	9		1	08/04/2014	2015.01	08/04/2014 07:30:59 AM Mountain Daylight Time	07/02/2014 07:34:34 AM Mountain Daylight Time	08/01/2014 08:28:55 AM Mountain Daylight Time			08/05/2014 06:34:03 PM Mountain Daylight Time	ALTIUS HEALTH PLANS, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra (HMO)	01	01		1			H8649	003	0	2015	Northern Utah		2	13500	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559		(800)708-3650		(800)708-3650		(855)338-9559		(855)338-9559		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8649	801	0	1	01	01	H8649_801_0	2		1	07/14/2014	2015.01	07/14/2014 06:24:27 PM Mountain Daylight Time	07/08/2014 03:01:52 PM Mountain Daylight Time				07/14/2014 06:26:30 PM Mountain Daylight Time	ALTIUS HEALTH PLANS, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Emp Calendar Year (HMO)	01	01		1			H8649	801	0	2015	State of Utah		1	0	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559		(800)708-3650		(800)708-3650		(855)338-9559		(855)338-9559		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8649	803	0	1	01	01	H8649_803_0	2		1	07/14/2014	2015.01	07/14/2014 10:15:26 PM Mountain Daylight Time	07/08/2014 03:01:52 PM Mountain Daylight Time				07/14/2014 10:17:01 PM Mountain Daylight Time	ALTIUS HEALTH PLANS, INC.	Altius Health Plans	www.altiusadvantra.com	Altius Advantra Emp MA Only (HMO)	01	01		1			H8649	803	0	2015	State of Utah		1	0	2			2							www.altiusadvantra.com	http://AltiusFormulary.coventry-medicare.com	http://PharmacyLocator.coventry-medicare.com	(866)784-4918		(866)784-4918		(855)338-9559		(855)338-9559										(711)-		(711)-		(711)-		(711)-										2					2					2
H8655	004	0	1	20	08	H8655_004_0	1		1	05/28/2014	2015.01	05/28/2014 01:22:55 PM Eastern Daylight Time		05/27/2014 02:20:03 PM Eastern Daylight Time			05/28/2014 01:23:25 PM Eastern Daylight Time	RIVERSIDE RETIREMENT SERVICES, INC.	Riverside PACE	www.riversideonline.com	Riverside PACE Dual (PACE)	08	20		1			H8655	004	0	2015	Riverside PACE Dual		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050										(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050												
H8655	005	0	1	20	08	H8655_005_0	1		1	05/28/2014	2015.01	05/28/2014 01:22:43 PM Eastern Daylight Time		05/27/2014 02:28:48 PM Eastern Daylight Time			05/28/2014 01:23:25 PM Eastern Daylight Time	RIVERSIDE RETIREMENT SERVICES, INC.	Riverside PACE	www.riversideonline.com	Riverside PACE Medicare ONLY (PACE)	08	20		1			H8655	005	0	2015	Riverside PACE Medicare ONLY		2		2			2								N/A - no formulary	www.riversideonline.com									(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050										(800)675-6368		(757)875-2050		(800)675-6368		(757)875-2050												
H8677	001	0	1	48	05	H8677_001_0	4		1	06/30/2014	2015.01	06/30/2014 11:56:43 AM Pacific Daylight Time					06/30/2014 12:14:27 PM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8677	001	0	2015	Southern California		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8677	002	0	1	48	05	H8677_002_0	4		1	08/18/2014	2015.01	08/18/2014 09:21:23 AM Pacific Daylight Time					08/18/2014 10:59:29 AM Pacific Daylight Time	MOLINA HEALTHCARE OF CALIFORNIA	Molina Healthcare of California	www.molinahealthcare.com/duals	Molina Dual Options (Medicare-Medicaid Plan)	05	48		1			H8677	002	0	2015	Los Angeles		2		2			2							www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	www.molinahealthcare.com/duals	(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(855)665-4627		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8748	002	0	1	01	01	H8748_002_0	2		1	05/30/2014	2015.02	05/30/2014 04:29:53 PM Central Daylight Time	08/04/2014 02:32:24 PM Central Daylight Time	07/31/2014 03:27:53 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete (HMO)	01	01		1			H8748	002	0	2015	Greenville county		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8764	001	0	1	01	01	H8764_001_0	6		1	08/05/2014	2015.02	08/05/2014 01:30:25 PM Central Daylight Time	08/05/2014 04:04:45 PM Central Daylight Time	08/06/2014 07:42:13 AM Central Daylight Time			08/06/2014 03:56:01 PM Central Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage (HMO)	01	01		1			H8764	001	0	2015	Monterey County		2		2			2							www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(855)570-1600		(831)574-4938		(866)632-7958		(866)632-7958		(855)570-1600		(831)574-4938		(855)332-7195		(831)574-4940		(855)332-7195		(831)574-4940		(866)706-4757		(866)706-4757		(855)332-7195		(831)574-4940		2					2					2
H8764	002	0	1	02	01	H8764_002_0	6		1	08/06/2014	2015.02	08/06/2014 03:41:46 PM Central Daylight Time	08/05/2014 04:05:57 PM Central Daylight Time	08/06/2014 08:00:27 AM Central Daylight Time			08/06/2014 03:56:01 PM Central Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage Plus (HMO-POS)	01	02		1			H8764	002	0	2015	Monterey County		2		2			2							www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(855)570-1600		(831)574-4938		(866)632-7958		(866)632-7958		(855)570-1600		(831)574-4938		(855)332-7195		(831)574-4940		(855)332-7195		(831)574-4940		(866)706-4757		(866)706-4757		(855)332-7195		(831)574-4940		2					2					2
H8764	003	0	1	01	01	H8764_003_0	6		1	08/05/2014	2015.02	08/05/2014 01:34:08 PM Central Daylight Time	08/05/2014 04:07:17 PM Central Daylight Time	08/06/2014 08:10:53 AM Central Daylight Time			08/06/2014 03:56:01 PM Central Daylight Time	ASPIRE HEALTH PLAN	Aspire Health Plan	www.aspirehealthplan.org	Aspire Health Advantage Value (HMO)	01	01		1			H8764	003	0	2015	Monterey County		2		2			2							www.aspirehealthplan.org	www.aspirehealthplan.org	www.aspirehealthplan.org	(855)570-1600		(831)574-4938		(855)570-1600		(831)574-4938		(866)632-7958		(866)632-7958		(855)570-1600		(831)574-4938		(855)332-7195		(831)574-4940		(855)332-7195		(831)574-4940		(866)706-4757		(866)706-4757		(855)332-7195		(831)574-4940		2					2					2
H8777	001	0	1	20	08	H8777_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:13:44 PM Eastern Daylight Time		05/28/2014 10:53:54 AM Eastern Daylight Time			05/28/2014 01:18:56 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	completeseniorcare.org	Complete Senior Care Dual (PACE)	08	20		1			H8777	001	0	2015	Niagara, NY		2		2			2								completeseniorcare.org	completeseniorcare.org									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220											
H8777	002	0	1	20	08	H8777_002_0	1		1	05/28/2014	2015.01	05/28/2014 01:14:08 PM Eastern Daylight Time		05/28/2014 10:58:56 AM Eastern Daylight Time			05/28/2014 01:18:56 PM Eastern Daylight Time	COMPLETE SENIOR CARE, INC.	Complete Senior Care	completeseniorcare.org	Complete Senior Care Medicare Only (PACE)	08	20		1			H8777	002	0	2015	Niagara, NY		2		2			2								completeseniorcare.org	completeseniorcare.org									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220									(716)285-8224	220	(716)285-8224	220	(716)285-8224	220	(716)285-8224	220											
H8800	001	0	1	20	08	H8800_001_0	1		1	05/20/2014	2015.01	05/20/2014 01:36:24 PM Eastern Daylight Time		05/20/2014 02:10:00 PM US Eastern Daylight Time			05/21/2014 07:23:39 AM US Eastern Daylight Time	TOTAL SENIOR CARE, INC.	Total Senior Care, Inc.	www.totalseniorcare.org	Total Senior Care - Dual (PACE)	08	20		1			H8800	001	0	2015	Total Senior Care, Inc.		2		2			2								www.totalseniorcare.org	totalseniorcare.org									(866)939-8613		(716)379-8474		(866)939-8613		(716)379-8474										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220												
H8800	002	0	1	20	08	H8800_002_0	1		1	05/20/2014	2015.01	05/20/2014 01:36:53 PM Eastern Daylight Time		05/20/2014 02:10:00 PM US Eastern Daylight Time			05/21/2014 07:23:39 AM US Eastern Daylight Time	TOTAL SENIOR CARE, INC.	Total Senior Care, Inc.	totalseniorcare.org	Total Senior Care - Medicare Small Only (PACE)	08	20		1			H8800	002	0	2015	Total Senior Care, Inc.		2		2			2								www.totalseniorcare.org	totalseniorcare.org									(866)939-8613		(716)379-8474		(866)939-8613		(716)379-8474										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220												
H8822	004	0	1	01	01	H8822_004_0	12		1	07/22/2014	2015.01	07/22/2014 09:46:58 AM Eastern Daylight Time	08/07/2014 07:38:47 AM Eastern Daylight Time	08/07/2014 07:38:47 AM Eastern Daylight Time			08/07/2014 11:18:03 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Network (HMO)	01	01		1			H8822	004	0	2015	Central Indiana and St. Joseph County		2	1645	2			2							www.advantageplan.com/MAPlans	www.advantageplan.com	www.advantageplan.com	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					2
H8822	005	0	1	01	01	H8822_005_0	12	2	1	07/14/2014	2015.01	07/14/2014 04:58:03 PM Eastern Daylight Time	08/07/2014 07:39:23 AM Eastern Daylight Time	08/07/2014 07:39:57 AM Eastern Daylight Time			08/07/2014 11:18:03 AM Eastern Daylight Time	ADVANTAGE HEALTH SOLUTIONS, INC.	ADVANTAGE Health Solutions, Inc.	www.advantageplan.com/MAplans	ADVANTAGE Special Needs Plan (HMO SNP)	01	01		1			H8822	005	0	2015	Central Indiana		2	126	2			1	3		1	2			www.advantageplan.com/MAPlans	www.advantageplan.com	www.advantageplan.com	(800)523-7533		(317)573-7950		(800)201-8342		(800)201-8342		(877)684-0014	1	(877)684-0014	1	(800)201-8342		(800)201-8342		(800)743-3333		(800)743-3333		(800)743-3333		(800)743-3333		(866)763-9630		(866)763-9630		(800)743-3333		(800)743-3333		2					2					2
H8851	001	0	1	48	05	H8851_001_0	7		1	07/23/2014	2015.01	07/23/2014 03:39:08 PM Eastern Daylight Time					07/23/2014 03:50:32 PM Eastern Daylight Time	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Senior Whole Health of New York	www.seniorwholehealth.com	Senior Whole Health of New York (Medicare-Medicaid Plan)	05	48		1			H8851	001	0	2015	Senior Whole Health of New York		2	100	2			2							www.seniorwholehealth.com	www.seniorwholehealth.com	www.seniorwholehealth.com	(877)353-0185		(518)472-5200		(877)353-0188		(518)472-5200		(877)353-0185		(518)472-5200		(877)353-0188		(518)472-5200		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8908	001	0	1	01	01	H8908_001_0	3		1	07/10/2014	2015.02	07/10/2014 01:54:30 PM Eastern Daylight Time	08/04/2014 10:22:35 PM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Gold Plus H8908-001 (HMO)	01	01		1			H8908	001	0	2015	Ingham, Macomb, Wayne and Washtenaw counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8908	801	0	1	01	01	H8908_801_0	3		1	05/23/2014	2015.02	05/23/2014 02:59:07 PM Eastern Daylight Time	07/14/2014 11:08:14 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8908	801	0	2015	Ingham, Macomb, Wayne and Washtenaw counties		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H8908	802	0	1	01	01	H8908_802_0	3		1	05/23/2014	2015.02	05/23/2014 02:59:46 PM Eastern Daylight Time	07/14/2014 11:08:45 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Humana Medical Plan of Michigan, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8908	802	0	2015	Ingham, Macomb, Wayne and Washtenaw counties		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H8953	001	0	1	01	01	H8953_001_0	3		1	08/02/2014	2015.02	08/02/2014 11:31:34 AM Eastern Daylight Time	08/05/2014 09:39:07 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-001 (HMO)	01	01		1			H8953	001	0	2015	Greater Cincinnati Area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	002	0	1	01	01	H8953_002_0	3		1	08/02/2014	2015.02	08/02/2014 11:36:00 AM Eastern Daylight Time	08/05/2014 09:41:46 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-002 (HMO)	01	01		1			H8953	002	0	2015	Cuyahoga, Lake, Lorain and Medina counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	003	0	1	01	01	H8953_003_0	3		1	08/02/2014	2015.02	08/02/2014 11:43:30 AM Eastern Daylight Time	08/05/2014 09:42:07 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-003 (HMO)	01	01		1			H8953	003	0	2015	Greene, Montgomery and Preble counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	005	0	1	01	01	H8953_005_0	3		1	08/02/2014	2015.02	08/02/2014 11:47:22 AM Eastern Daylight Time	08/05/2014 09:44:56 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-005 (HMO)	01	01		1			H8953	005	0	2015	Columbus Metro area		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	006	0	1	01	01	H8953_006_0	3		1	08/02/2014	2015.02	08/02/2014 11:50:21 AM Eastern Daylight Time	08/05/2014 09:45:19 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-006 (HMO)	01	01		1			H8953	006	0	2015	Carroll, Portage, Stark, Summit and Wayne counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	007	0	1	01	01	H8953_007_0	4	2	1	08/02/2014	2015.02	08/02/2014 11:52:30 AM Eastern Daylight Time	08/05/2014 09:45:38 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H8953-007 (HMO SNP)	01	01		1			H8953	007	0	2015	Select Counties in Ohio		2		2			1	3		1	5			www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	009	0	1	01	01	H8953_009_0	3		1	08/02/2014	2015.02	08/02/2014 11:54:48 AM Eastern Daylight Time	08/05/2014 09:54:04 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-009 (HMO)	01	01		1			H8953	009	0	2015	Mahoning and Trumbull counties		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	010	0	1	01	01	H8953_010_0	3		1	08/02/2014	2015.02	08/02/2014 11:57:05 AM Eastern Daylight Time	08/05/2014 09:50:00 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus H8953-010 (HMO)	01	01		1			H8953	010	0	2015	Select Counties in Ohio		2		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	011	0	1	01	01	H8953_011_0	3		1	08/04/2014	2015.02	08/04/2014 04:38:51 PM Eastern Daylight Time	08/05/2014 09:50:41 AM Eastern Daylight Time	08/04/2014 05:04:19 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H8953-011 (HMO SNP)	01	01		1			H8953	011	0	2015	Greater Cincinnati Area		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	012	0	1	01	01	H8953_012_0	3		1	08/04/2014	2015.02	08/04/2014 04:38:55 PM Eastern Daylight Time	08/05/2014 09:51:34 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-CVD/CHF/DM H8953-012 (HMO SNP)	01	01		1			H8953	012	0	2015	Delaware, Fairfield, Franklin and Licking counties		2		2			1	4		1		00000000000000000010		www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	014	0	1	01	01	H8953_014_0	4	2	1	08/04/2014	2015.02	08/04/2014 03:57:07 PM Eastern Daylight Time	08/05/2014 09:52:56 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 09:57:42 AM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Gold Plus SNP-DE H8953-014 (HMO SNP)	01	01		1			H8953	014	0	2015	Northern Kentucky Area		2		2			1	3		1	1			www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H8953	801	0	1	01	01	H8953_801_0	3		1	05/23/2014	2015.02	05/23/2014 03:00:28 PM Eastern Daylight Time	07/14/2014 10:47:35 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8953	801	0	2015	Select counties in Cincinnati metro area		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H8953	802	0	1	01	01	H8953_802_0	3		1	05/23/2014	2015.02	05/23/2014 03:01:07 PM Eastern Daylight Time	07/14/2014 10:49:43 AM Eastern Daylight Time				07/14/2014 02:09:14 PM Eastern Daylight Time	HUMANA HEALTH PLAN OF OHIO, INC.	Humana Health Plan of Ohio, Inc.	www.humana-medicare.com	Humana Medicare Employer (HMO)	01	01		1			H8953	802	0	2015	Select counties in Cincinnati metro area		1		2			2							www.humana.com/members/tools	http://www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	http://www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					1
H8980	002	0	1	04	01	H8980_002_0	6		1	08/04/2014	2015.01	08/04/2014 08:37:44 AM Central Daylight Time	08/04/2014 07:09:00 PM Central Daylight Time	08/01/2014 09:29:04 AM Central Daylight Time			08/06/2014 02:08:32 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.pa.chcadvantra.com	Advantra Silver (PPO)	01	04		1			H8980	002	0	2015	Northeastern Ohio		2	10027	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(877)300-5135		(877)300-5135		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8980	004	0	1	04	01	H8980_004_0	4		1	08/03/2014	2015.01	08/03/2014 01:48:28 PM Central Daylight Time	08/04/2014 07:10:56 PM Central Daylight Time	08/01/2014 09:29:15 AM Central Daylight Time			08/06/2014 02:08:32 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.pa.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H8980	004	0	2015	Northeastern Ohio		2	1294	2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(855)893-4695		(855)893-4695		(877)300-5135		(877)300-5135		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8980	005	0	1	04	01	H8980_005_0	5		1	08/04/2014	2015.01	08/04/2014 11:38:59 AM Eastern Daylight Time	08/05/2014 11:34:16 AM Eastern Daylight Time	08/01/2014 10:29:25 AM Eastern Daylight Time			08/05/2014 11:42:41 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H8980	005	0	2015	Northern West Virginia		2		2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)893-4695		(855)893-4695		(866)295-6206		(866)295-6206		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8980	006	0	1	04	01	H8980_006_0	4		1	08/04/2014	2015.01	08/04/2014 11:41:18 AM Eastern Daylight Time	08/05/2014 11:34:39 AM Eastern Daylight Time	08/01/2014 10:29:35 AM Eastern Daylight Time			08/05/2014 11:42:41 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H8980	006	0	2015	Southern West Virginia		2		2			2							http://providerdirectory.coventry-medicare.com	http://WVformulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(888)365-6052		(888)365-6052		(855)893-4695		(855)893-4695		(866)295-6206		(866)295-6206		(855)893-4695		(855)893-4695		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H8980	801	0	1	04	01	H8980_801_0	1		1	05/29/2014	2015.01	05/29/2014 03:53:50 PM Eastern Daylight Time	05/31/2014 08:42:26 AM Eastern Daylight Time				05/31/2014 08:45:26 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra MA Only (PPO)	01	04		1			H8980	801	0	2015	West Virginia		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	011111111010100111111111111111011100	2		1					
H8980	802	0	1	04	01	H8980_802_0	1		1	05/29/2014	2015.01	05/29/2014 03:57:55 PM Eastern Daylight Time	05/31/2014 08:42:38 AM Eastern Daylight Time				05/31/2014 08:45:26 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.wv.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H8980	802	0	2015	West Virginia		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272		(877)300-5135		(877)300-5135		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111010100111111111111111011100	2		1					
H8980	805	0	1	04	01	H8980_805_0	1		1	04/25/2014	2015.01	05/09/2014 09:26:58 AM Central Daylight Time	05/29/2014 10:51:10 PM Central Daylight Time				05/31/2014 01:40:29 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra EmpGrp/Rx/Cyear (PPO)	01	04		1			H8980	805	0	2015	Ohio		1		2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272		(877)300-5135		(877)300-5135		(800)470-4272		(800)470-4272		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100010001100111111111011110001110	2		1					
H8980	807	0	1	04	01	H8980_807_0	1		1	05/21/2014	2015.01	05/30/2014 03:09:06 PM Central Daylight Time	05/29/2014 10:55:24 PM Central Daylight Time				05/31/2014 01:40:29 AM Central Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://www.pa.chcadvantra.com	Advantra EmpGrp/NoRx/Cyear (PPO)	01	04		1			H8980	807	0	2015	Ohio		1	500	2			2							http://providerdirectory.coventry-medicare.com	http://PAFormulary.coventry-medicare.com	http://pharmacylocator.coventry-medicare.com	(800)290-0190		(800)290-0190		(800)470-4272		(800)470-4272										(711)-		(711)-		(711)-		(711)-										1	1	011111111001100111110111011110000110	2		1					
H8991	017	0	1	01	01	H8991_017_0	10	2	1	08/04/2014	2015.01	08/04/2014 09:59:44 AM Pacific Daylight Time	08/06/2014 11:28:40 AM Pacific Daylight Time	08/06/2014 01:06:42 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	AMERIGROUP FLORIDA, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Specialty + Rx (HMO SNP)	01	01		1			H8991	017	0	2015	South and Central Florida		2	3887	2			1	3		1	5			www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H8991	028	0	1	01	01	H8991_028_0	11		1	08/04/2014	2015.01	08/04/2014 10:02:08 AM Pacific Daylight Time	08/06/2014 11:29:03 AM Pacific Daylight Time	08/06/2014 01:06:45 PM Pacific Daylight Time			08/06/2014 03:45:39 PM Pacific Daylight Time	AMERIGROUP FLORIDA, INC.	Amerigroup	www.myamerigroup.com/medicare	Amerivantage Classic + Rx (HMO)	01	01		1			H8991	028	0	2015	South and Central Florida		2	250	2			2							www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	www.myamerigroup.com/medicare	(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(866)805-4589		(866)805-4589		(877)470-4131		(877)470-4131		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		(800)855-2880		2					2					2
H9001	001	0	1	01	01	H9001_001_0	6		1	07/30/2014	2015.02	07/30/2014 12:15:59 PM Eastern Daylight Time	07/28/2014 04:44:04 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Standard (HMO)	01	01		1			H9001	001	0	2015	Worcester County and parts of Franklin County		2	307	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2
H9001	013	0	1	02	01	H9001_013_0	8		1	08/05/2014	2015.02	08/05/2014 12:04:10 PM Eastern Daylight Time	08/06/2014 04:20:40 PM Eastern Daylight Time	08/06/2014 04:22:02 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced Rx (HMO-POS)	01	02		1			H9001	013	0	2015	Worcester County and parts of Franklin County		2	4463	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	015	0	1	01	01	H9001_015_0	7		1	08/05/2014	2015.02	08/05/2014 12:04:14 PM Eastern Daylight Time	08/06/2014 04:20:41 PM Eastern Daylight Time	08/06/2014 04:22:03 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Standard Enhanced Rx (HMO)	01	01		1			H9001	015	0	2015	Worcester County and parts of Franklin County		2	1389	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	019	0	1	01	01	H9001_019_0	7	2	1	08/05/2014	2015.02	08/05/2014 05:59:47 PM Eastern Daylight Time	08/06/2014 04:19:39 PM Eastern Daylight Time	08/06/2014 04:22:03 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.navicare.org	NaviCare (HMO SNP)	01	01		1			H9001	019	0	2015	MA except counties: BER, DUK, NAN and parts of FRA		2	4858	2			1	3		1	5			www.navicare.org/FindPhysician	www.navicare.org/medicare-formulary	www.navicare.org/medicare-pharmacy	(877)700-6996		(877)700-6996		(877)255-7108		(877)255-7108		(877)700-6996		(877)700-6996		(877)255-7108		(877)255-7108		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					1					1
H9001	029	1	1	01	01	H9001_029_1	6		1	07/30/2014	2015.02	07/30/2014 12:16:27 PM Eastern Daylight Time	07/28/2014 04:47:00 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	1	2015	MA except counties: BER, DUK, NAN and parts of FRA	Essex and Suffolk counties	2	12	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2
H9001	029	2	1	01	01	H9001_029_2	6		1	07/30/2014	2015.02	07/30/2014 12:16:33 PM Eastern Daylight Time	07/28/2014 04:49:30 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	2	2015	MA except counties: BER, DUK, NAN and parts of FRA	Middlesex, Norfolk, Bristol and Plymouth counties	2	99	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2
H9001	029	4	1	01	01	H9001_029_4	6		1	07/30/2014	2015.02	07/30/2014 12:16:39 PM Eastern Daylight Time	07/28/2014 04:50:10 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	4	2015	MA except counties: BER, DUK, NAN and parts of FRA	Barnstable county	2	1	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2
H9001	029	5	1	01	01	H9001_029_5	5		1	07/21/2014	2015.02	07/21/2014 02:37:25 PM Eastern Daylight Time	06/02/2014 08:52:07 PM Eastern Daylight Time				07/21/2014 03:21:01 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	5	2015	MA except counties: BER, DUK, NAN and parts of FRA	Hampden and Hampshire counties	2	79	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2
H9001	029	6	1	01	01	H9001_029_6	6		1	07/30/2014	2015.02	07/30/2014 12:17:00 PM Eastern Daylight Time	07/28/2014 04:50:50 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver (HMO)	01	01		1			H9001	029	6	2015	MA except counties: BER, DUK, NAN and parts of FRA	Worcester and parts of Franklin	2	296	2			2							www.fallonhealth.org/FindPhysician	www.fchp.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980										(711)-		(711)-		(711)-		(711)-										2					2					2
H9001	030	1	1	01	01	H9001_030_1	8		1	08/07/2014	2015.02	08/07/2014 10:53:02 AM Eastern Daylight Time	08/06/2014 04:19:46 PM Eastern Daylight Time	08/06/2014 04:21:32 PM Eastern Daylight Time			08/07/2014 11:24:00 AM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	1	2015	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Essex and Suffolk counties	2	50	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	030	2	1	01	01	H9001_030_2	7		1	08/05/2014	2015.02	08/05/2014 12:05:02 PM Eastern Daylight Time	08/06/2014 04:19:52 PM Eastern Daylight Time	08/06/2014 04:21:35 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	2	2015	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Middlesex, Norfolk, Bristol and Plymouth counties	2	535	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	030	4	1	01	01	H9001_030_4	7		1	08/05/2014	2015.02	08/05/2014 12:05:07 PM Eastern Daylight Time	08/06/2014 04:19:58 PM Eastern Daylight Time	08/06/2014 04:21:38 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	4	2015	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Barnstable county	2	7	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	030	5	1	01	01	H9001_030_5	7		1	08/05/2014	2015.02	08/05/2014 12:05:13 PM Eastern Daylight Time	08/06/2014 04:20:03 PM Eastern Daylight Time	08/06/2014 04:21:42 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Saver Enhanced RX (HMO)	01	01		1			H9001	030	5	2015	Cntys: BAR, BRI, ESS, HMD, HMP, MID, NOR, PLY, SUF	Hampden and Hampshire counties	2	731	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	031	1	1	01	01	H9001_031_1	7		1	08/05/2014	2015.02	08/05/2014 12:05:18 PM Eastern Daylight Time	08/06/2014 04:20:08 PM Eastern Daylight Time	08/06/2014 04:21:45 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	1	2015	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Essex and Suffolk counties	2	13	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	031	2	1	01	01	H9001_031_2	7		1	08/05/2014	2015.02	08/05/2014 12:05:23 PM Eastern Daylight Time	08/06/2014 04:20:13 PM Eastern Daylight Time	08/06/2014 04:21:47 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	2	2015	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Middlesex, Norfolk, Bristol and Plymouth counties	2	513	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	031	4	1	01	01	H9001_031_4	7		1	08/05/2014	2015.02	08/05/2014 12:06:16 PM Eastern Daylight Time	08/06/2014 04:20:17 PM Eastern Daylight Time	08/06/2014 04:21:49 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	4	2015	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Barnstable county	2	6	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	031	6	1	01	01	H9001_031_6	7		1	08/05/2014	2015.02	08/05/2014 12:06:22 PM Eastern Daylight Time	08/06/2014 04:20:21 PM Eastern Daylight Time	08/06/2014 04:21:51 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced RX (HMO)	01	01		1			H9001	031	6	2015	BAR, BRI, ESS, MID, NOR, SUF, WOR, and part of FRA	Worcester and parts of Franklin	2	992	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	032	1	1	01	01	H9001_032_1	7		1	08/05/2014	2015.02	08/05/2014 12:06:27 PM Eastern Daylight Time	08/06/2014 04:20:25 PM Eastern Daylight Time	08/06/2014 04:21:53 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	1	2015	MA except counties: BER, DUK, NAN and parts of FRA	Essex and Suffolk counties	2	81	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	032	2	1	01	01	H9001_032_2	7		1	08/05/2014	2015.02	08/05/2014 12:06:31 PM Eastern Daylight Time	08/06/2014 04:20:28 PM Eastern Daylight Time	08/06/2014 04:21:55 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	2	2015	MA except counties: BER, DUK, NAN and parts of FRA	Middlesex, Norfolk, Bristol and Plymouth counties	2	135	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	032	4	1	01	01	H9001_032_4	7		1	08/05/2014	2015.02	08/05/2014 12:06:35 PM Eastern Daylight Time	08/06/2014 04:20:31 PM Eastern Daylight Time	08/06/2014 04:21:56 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	4	2015	MA except counties: BER, DUK, NAN and parts of FRA	Barnstable county	2	9	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	032	5	1	01	01	H9001_032_5	7		1	08/05/2014	2015.02	08/05/2014 12:06:40 PM Eastern Daylight Time	08/06/2014 04:20:34 PM Eastern Daylight Time	08/06/2014 04:21:58 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	5	2015	MA except counties: BER, DUK, NAN and parts of FRA	Hampden and Hampshire counties	2	99	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	032	6	1	01	01	H9001_032_6	7		1	08/05/2014	2015.02	08/05/2014 12:06:44 PM Eastern Daylight Time	08/06/2014 04:20:36 PM Eastern Daylight Time	08/06/2014 04:21:59 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Super Saver Rx (HMO)	01	01		1			H9001	032	6	2015	MA except counties: BER, DUK, NAN and parts of FRA	Worcester and parts of Franklin	2	647	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	033	0	1	02	01	H9001_033_0	9		1	08/05/2014	2015.02	08/05/2014 12:06:50 PM Eastern Daylight Time	08/06/2014 04:20:38 PM Eastern Daylight Time	08/06/2014 04:22:00 PM Eastern Daylight Time			08/06/2014 04:40:23 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	Fallon Senior Plan Plus Enhanced Rx (HMO-POS)	01	02		1			H9001	033	0	2015	Hampden and Hampshire Counties		2	892	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9001	803	0	1	01	01	H9001_803_0	4		1	07/30/2014	2015.02	07/30/2014 03:02:05 PM Eastern Daylight Time	07/30/2014 01:34:07 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	MA-PD HMO (HMO)	01	01		1			H9001	803	0	2015	Full Service Area - Employer Groups		1	2607	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011111000100	1	111111111011110111110000000	1					1
H9001	804	0	1	02	01	H9001_804_0	5		1	07/30/2014	2015.02	07/30/2014 03:02:11 PM Eastern Daylight Time	07/30/2014 01:35:35 PM Eastern Daylight Time				07/30/2014 07:13:14 PM Eastern Daylight Time	FALLON COMMUNITY HEALTH PLAN	Fallon Health	www.fallonhealth.org/seniorplan	MA-PD HMO POS (HMO-POS)	01	02		1			H9001	804	0	2015	Full Service Area - Employer Groups		1	40	2			2							www.fallonhealth.org/FindPhysician	www.fallonhealth.org/medicare-formulary	www.fallonhealth.org/medicare-pharmacy	(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(800)325-5669		(800)325-5669		(888)377-1980		(888)377-1980		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011111000100	1	111111111011010111110000000	1	1	011111111011101111111111011111000100	1	111111111011010111110000000	1
H9003	001	0	1	01	01	H9003_001_0	9		1	07/23/2014	2015.01	07/23/2014 12:40:47 PM Pacific Daylight Time	07/31/2014 02:51:04 PM Pacific Daylight Time	07/31/2014 02:34:35 PM Pacific Daylight Time			08/04/2014 12:24:18 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage (HMO)	01	01		1			H9003	001	0	2015	Portland-Vancouver Metro, Salem OR, Longview WA		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9003	006	0	1	01	01	H9003_006_0	9		1	07/23/2014	2015.01	07/23/2014 12:30:50 PM Pacific Daylight Time	07/31/2014 02:53:29 PM Pacific Daylight Time	07/31/2014 02:46:35 PM Pacific Daylight Time			08/04/2014 12:24:18 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Kaiser Permanente Senior Advantage Basic (HMO)	01	01		1			H9003	006	0	2015	Portland-Vancouver Metro, Salem OR, Longview WA		2		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9003	801	0	1	01	01	H9003_801_0	4		1	05/27/2014	2015.01	05/27/2014 11:48:30 AM Pacific Daylight Time	05/28/2014 08:46:10 AM Pacific Daylight Time				05/28/2014 04:41:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only with Part D (HMO)	01	01		1			H9003	801	0	2015	Portland-Vancouver Metro, Salem OR, Longview WA		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	011111111011111111111111111	1					2
H9003	802	0	1	01	01	H9003_802_0	4		1	05/27/2014	2015.01	05/27/2014 11:49:55 AM Pacific Daylight Time	05/28/2014 08:48:37 AM Pacific Daylight Time				05/28/2014 04:41:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	Employer Group Only without Part D (HMO)	01	01		1			H9003	802	0	2015	Portland-Vancouver Metro, Salem OR, Longview WA		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	011111111011111111111111111	1					2
H9003	805	0	1	01	01	H9003_805_0	4		1	05/27/2014	2015.01	05/27/2014 11:50:54 AM Pacific Daylight Time	05/28/2014 08:50:56 AM Pacific Daylight Time				05/28/2014 04:41:39 PM Pacific Daylight Time	KAISER FOUNDATION HP OF THE N W	Kaiser Permanente	kp.org/medicare	FEHB AB with D (HMO)	01	01		1			H9003	805	0	2015	Portland-Vancouver Metro, Salem OR, Longview WA		1		2			2							kp.org/medicare	kp.org/seniorrx	kp.org/seniorrx	(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(877)221-8221		(877)221-8221		(877)408-3496		(877)408-3496		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	011111111011111111111111111	1					2
H9047	001	0	1	01	01	H9047_001_0	10		1	08/01/2014	2015.01	08/01/2014 07:46:26 AM Pacific Daylight Time	08/05/2014 10:25:54 PM Pacific Daylight Time	08/05/2014 10:30:10 PM Pacific Daylight Time			08/06/2014 10:53:38 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Extra + RX (HMO)	01	01		1			H9047	001	0	2015	Portland Metro, Willamette Valley, Clark County		2	173774	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	013	0	2	01	01	H9047_013_0	11		1	07/22/2014	2015.01	07/22/2014 04:02:03 PM Pacific Daylight Time	08/05/2014 10:26:31 PM Pacific Daylight Time	08/05/2014 10:30:37 PM Pacific Daylight Time			08/06/2014 10:53:38 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Extra Part B Only + RX (HMO)	01	01		2	2		H9047	013	0	2015	Portland Metro and Willamette Valley		2	4	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	024	0	1	02	01	H9047_024_0	13		1	08/12/2014	2015.01	08/12/2014 10:27:59 AM Pacific Daylight Time	08/05/2014 10:27:05 PM Pacific Daylight Time	08/05/2014 10:31:07 PM Pacific Daylight Time			08/12/2014 10:55:25 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Choice + RX (HMO-POS)	01	02		1			H9047	024	0	2015	Portland Metro, Willamette Valley, Clark County		2	184540	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	033	0	1	01	01	H9047_033_0	8		1	07/22/2014	2015.01	07/22/2014 04:01:44 PM Pacific Daylight Time	07/17/2014 09:32:10 AM Pacific Daylight Time				07/23/2014 08:43:30 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Extra (HMO)	01	01		1			H9047	033	0	2015	Portland Metro, Willamette Valley, Clark County		2	16278	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2
H9047	035	0	1	02	01	H9047_035_0	10		1	07/25/2014	2015.01	07/25/2014 12:03:50 PM Pacific Daylight Time	07/17/2014 09:32:38 AM Pacific Daylight Time				07/25/2014 01:04:28 PM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Choice (HMO-POS)	01	02		1			H9047	035	0	2015	Portland Metro, Willamette Valley, Clark County		2	16397	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2
H9047	037	0	1	02	01	H9047_037_0	9		1	08/05/2014	2015.01	08/05/2014 02:21:18 PM Pacific Daylight Time	08/05/2014 10:27:38 PM Pacific Daylight Time	08/05/2014 10:31:48 PM Pacific Daylight Time			08/06/2014 10:53:38 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Prime + RX (HMO-POS)	01	02		1			H9047	037	0	2015	Portland Metro		2	62461	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	038	0	1	02	01	H9047_038_0	9		1	07/29/2014	2015.01	07/29/2014 03:09:44 PM Pacific Daylight Time	08/05/2014 10:28:21 PM Pacific Daylight Time	08/05/2014 10:34:52 PM Pacific Daylight Time			08/06/2014 10:53:38 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Latitude + RX (HMO-POS)	01	02		1			H9047	038	0	2015	Central OR, Hood River		2	2396	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	039	0	1	02	01	H9047_039_0	10		1	07/29/2014	2015.01	07/29/2014 10:22:02 AM Pacific Daylight Time	08/05/2014 10:29:13 PM Pacific Daylight Time	08/05/2014 10:34:00 PM Pacific Daylight Time			08/06/2014 10:53:38 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Compass + RX (HMO-POS)	01	02		1			H9047	039	0	2015	Central OR, Hood River		2	2396	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	801	0	1	01	01	H9047_801_0	10		1	07/23/2014	2015.01	07/23/2014 07:22:59 AM Pacific Daylight Time	07/17/2014 09:33:03 AM Pacific Daylight Time				07/23/2014 08:43:30 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Align Group Plan (HMO)	01	01		1			H9047	801	0	2015	Portland Metro, Willamette Valley, Clark County		1	138200	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2
H9047	804	0	1	01	01	H9047_804_0	8		1	07/23/2014	2015.01	07/23/2014 06:32:13 AM Pacific Daylight Time	07/17/2014 09:33:27 AM Pacific Daylight Time				07/23/2014 08:43:30 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Align Group Plan + RX (HMO)	01	01		1			H9047	804	0	2015	Portland Metro, Willamette Valley, Clark County		1	21301	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	805	0	1	02	01	H9047_805_0	7		1	07/22/2014	2015.01	07/22/2014 03:57:14 PM Pacific Daylight Time	07/17/2014 09:33:51 AM Pacific Daylight Time				07/23/2014 08:43:30 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Flex Group Plan + RX (HMO-POS)	01	02		1			H9047	805	0	2015	Portland Metro, Willamette Valley, Clark County		1	146	2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9047	806	0	1	02	01	H9047_806_0	11		1	08/12/2014	2015.01	08/12/2014 10:32:21 AM Pacific Daylight Time	07/17/2014 09:35:15 AM Pacific Daylight Time				08/12/2014 10:55:25 AM Pacific Daylight Time	PROVIDENCE HEALTH PLAN	Providence Health Plans	www.providencehealthplan.com	Providence Medicare Flex Group Plan (HMO-POS)	01	02		1			H9047	806	0	2015	Portland Metro, Willamette Valley, Clark County		1		2			2							www.providencehealthplan.com	providencehealthplan.com	providencehealthplan.com	(800)603-2340		(503)574-8000		(800)457-6064		(503)574-5551										(711)-		(711)-		(711)-		(711)-										2					2					2
H9068	001	0	1	20	08	H9068_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:45:50 PM Eastern Daylight Time		05/28/2014 10:00:04 AM Eastern Daylight Time			05/28/2014 01:48:03 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE (PACE)	08	20		1			H9068	001	0	2015	Albright LIFE		2		2			2								www.albrightcare.org	www.albrightcare.org									(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880										(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880												
H9068	002	0	1	20	08	H9068_002_0	1		1	05/28/2014	2015.01	05/28/2014 01:46:23 PM Eastern Daylight Time		05/28/2014 10:08:07 AM Eastern Daylight Time			05/28/2014 01:48:03 PM Eastern Daylight Time	ALBRIGHT CARE SERVICES	ALBRIGHT CARE SERVICES	www.albrightlife.org	Albright LIFE Medicare Only (PACE)	08	20		1			H9068	002	0	2015	Albright LIFE		2		2			2								www.albrightcare.org	www.albrightcare.org									(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880										(570)522-3880		(570)522-3880		(570)522-3880		(570)522-3880												
H9082	007	0	1	01	01	H9082_007_0	10	2	1	08/05/2014	2015.01	08/05/2014 08:32:30 AM Pacific Daylight Time	08/05/2014 11:13:00 AM Pacific Daylight Time	08/05/2014 09:41:00 AM Pacific Daylight Time			08/06/2014 10:43:19 AM Pacific Daylight Time	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Molina Healthcare of New Mexico, Inc.	www.molinahealthcare.com/medicare	Molina Medicare Options Plus (HMO SNP)	01	01		1			H9082	007	0	2015	New Mexico		2		2			1	3		1	2			www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	www.molinahealthcare.com/medicare	(866)440-0127		(866)440-0127		(866)403-8293		(866)403-8293		(866)440-0127		(866)440-0127		(866)403-8293		(866)403-8293		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9104	006	0	1	01	01	H9104_006_0	7		1	08/03/2014	2015.01	08/03/2014 03:22:01 PM Pacific Daylight Time	08/05/2014 03:09:15 PM Pacific Daylight Time	07/31/2014 02:00:28 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN	SCAN Health Plan	www.scanhealthplan.com	SCAN Healthy at Home (HMO SNP)	01	01		1			H9104	006	0	2015	Los Angeles, Orange, and Inland Empire Areas		2		2			1	1	2	1				www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(800)559-3500		(800)559-3500		(800)915-7226		(800)915-7226		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9110	002	0	1	01	01	H9110_002_0	9		1	08/04/2014	2015.01	08/04/2014 10:21:09 PM Mountain Daylight Time	08/05/2014 10:10:22 AM Pacific Daylight Time	08/01/2014 08:32:24 AM Pacific Daylight Time			08/06/2014 10:57:21 AM Pacific Daylight Time	REGENCE BLUECROSS BLUESHIELD OF UTAH	Regence BlueCross BlueShield of Utah	www.regence.com/medicare	Regence BlueAdvantage HMO (HMO)	01	01		1			H9110	002	0	2015	Davis, Salt Lake, Utah, and Weber counties		2	100	2			2							www.regence.com/medicare	www.regence.com/medicare	www.regence.com/medicare	(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(855)522-8896		(855)522-8896		(888)369-3171		(888)369-3171		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9115	001	0	1	48	05	H9115_001_0	6		1	08/29/2014	2015.01	08/29/2014 10:57:52 AM Eastern Daylight Time					08/29/2014 10:59:02 AM Eastern Daylight Time	METROPLUS HEALTH PLAN, INC.	MetroPlus Health Plan	www.metroplusmedicare.org	MetroPlus FIDA (Medicare-Medicaid Plan)	05	48		1			H9115	001	0	2015	Kings, Queens, Bronx and New York Counties		2	522	2			2							www.metroplusmedicare.org	www.metroplus.org	www.caremark.com	(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(866)986-0356		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9122	001	0	1	01	01	H9122_001_0	8		1	08/04/2014	2015.01	08/04/2014 02:35:49 PM Eastern Daylight Time	08/04/2014 02:30:20 PM Eastern Daylight Time	08/04/2014 02:30:18 PM Eastern Daylight Time			08/04/2014 02:46:45 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	AlphaCare of New York, Inc.	www.alphacare.com/medicare	AlphaCare Renew (HMO)	01	01		1			H9122	001	0	2015	New York Metro Area		2		2			2								www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9122	002	0	1	01	01	H9122_002_0	8		1	07/15/2014	2015.01	07/15/2014 11:42:56 AM Eastern Daylight Time	08/04/2014 02:30:20 PM Eastern Daylight Time	08/04/2014 02:30:18 PM Eastern Daylight Time			08/04/2014 02:46:45 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	AlphaCare of New York, Inc.	www.alphacare.com/medicare	AlphaCare Resilience (HMO SNP)	01	01		1			H9122	002	0	2015	New York Metro Area		2		2			1	1	1	1					www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9122	003	0	1	01	01	H9122_003_0	10	2	1	07/18/2014	2015.01	07/18/2014 05:46:41 PM Eastern Daylight Time	08/04/2014 02:30:18 PM Eastern Daylight Time	08/04/2014 02:30:18 PM Eastern Daylight Time			08/04/2014 02:46:45 PM Eastern Daylight Time	ALPHACARE OF NEW YORK, INC.	AlphaCare of New York, Inc.	www.alphacare.com/medicare	AlphaCare Total (HMO SNP)	01	01		1			H9122	003	0	2015	New York Metro Area		2		2			1	3		1	2				www.alphacare.com	www.alphacare.com	(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(855)652-5742		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9185	001	0	1	20	08	H9185_001_0	1		1	11/12/2014	2015.03	11/12/2014 12:22:22 PM Eastern Standard Time		11/12/2014 09:49:44 AM Eastern Standard Time			11/12/2014 12:39:18 PM Eastern Standard Time	A&D CHARITIBLE FOUNDATION, INC.	Great Lakes PACE	http://www.a-dhomecare.com	Great Lakes PACE (PACE)	08	20		1			H9185	001	0	2015	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2								www.a-dhomecare.com	www.a-dhomecare.com									(844)445-7223		(989)249-0929		(844)445-7223		(989)249-0929										(771)-		(771)-		(771)-		(771)-												
H9185	002	0	1	20	08	H9185_002_0	1		1	11/12/2014	2015.03	11/12/2014 12:25:46 PM Eastern Standard Time		11/12/2014 09:49:45 AM Eastern Standard Time			11/12/2014 12:39:18 PM Eastern Standard Time	A&D CHARITIBLE FOUNDATION, INC.	Great Lakes PACE	http://www.a-dhomecare.com	Great Lakes PACE (PACE)	08	20		1			H9185	002	0	2015	Great Lakes Bay Region: Saginaw, Midland, Bay, Tus		2		2			2								www.a-dhomecare.com	www.a-dhomecare.com									(844)445-7223		(989)249-0929		(844)445-7223		(989)249-0929										(771)-		(771)-		(771)-		(771)-												
H9190	001	0	1	01	01	H9190_001_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:47:25 AM Eastern Daylight Time	08/04/2014 11:11:06 AM Eastern Daylight Time	07/31/2014 04:07:39 PM Eastern Daylight Time			08/06/2014 02:00:50 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	001	0	2015	Ohio Counties		2	600	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	002	0	1	01	01	H9190_002_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:49:54 AM Eastern Daylight Time	08/04/2014 10:26:40 AM Eastern Daylight Time	07/31/2014 04:09:40 PM Eastern Daylight Time			08/06/2014 02:03:08 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	002	0	2015	Ohio Counties		2	400	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	003	0	1	01	01	H9190_003_0	6		1	07/22/2014	2015.01	07/22/2014 02:06:56 PM Eastern Daylight Time	08/04/2014 10:27:00 AM Eastern Daylight Time	07/31/2014 04:09:48 PM Eastern Daylight Time			08/06/2014 02:06:43 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H9190	003	0	2015	Ohio Counties		2	250	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	004	0	1	01	01	H9190_004_0	6		1	07/22/2014	2015.01	07/22/2014 02:07:07 PM Eastern Daylight Time	08/04/2014 10:27:17 AM Eastern Daylight Time	07/31/2014 04:09:58 PM Eastern Daylight Time			08/06/2014 02:10:11 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H9190	004	0	2015	Ohio Counties		2	400	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	005	0	1	01	01	H9190_005_0	7		1	07/24/2014	2015.01	07/24/2014 12:16:45 PM Eastern Daylight Time	08/04/2014 10:27:35 AM Eastern Daylight Time	07/31/2014 04:10:09 PM Eastern Daylight Time			08/06/2014 02:12:54 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Choice (HMO)	01	01		1			H9190	005	0	2015	Ohio Counties		2	200	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	006	0	1	01	01	H9190_006_0	6		1	07/22/2014	2015.01	07/22/2014 02:07:43 PM Eastern Daylight Time	08/04/2014 10:27:53 AM Eastern Daylight Time	07/31/2014 04:10:18 PM Eastern Daylight Time			08/06/2014 02:14:55 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Prime (HMO)	01	01		1			H9190	006	0	2015	Ohio Counties		2	200	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	007	0	1	01	01	H9190_007_0	7	2	1	07/25/2014	2015.01	07/25/2014 04:23:24 PM Eastern Daylight Time	08/04/2014 11:11:23 AM Eastern Daylight Time	07/31/2014 04:10:29 PM Eastern Daylight Time			08/06/2014 02:16:59 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	007	0	2015	North Carolina Counties		2	500	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	008	0	1	01	01	H9190_008_0	7	2	1	07/25/2014	2015.01	07/25/2014 04:24:17 PM Eastern Daylight Time	08/04/2014 10:28:29 AM Eastern Daylight Time	07/31/2014 04:10:39 PM Eastern Daylight Time			08/06/2014 02:18:54 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	008	0	2015	North Carolina Counties		2	250	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	009	0	1	01	01	H9190_009_0	6		1	07/22/2014	2015.01	07/22/2014 02:08:17 PM Eastern Daylight Time	08/04/2014 10:31:11 AM Eastern Daylight Time	07/31/2014 04:11:10 PM Eastern Daylight Time			08/06/2014 02:39:05 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H9190	009	0	2015	North Carolina Counties		2	150	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	010	0	1	01	01	H9190_010_0	6		1	07/22/2014	2015.01	07/22/2014 02:08:43 PM Eastern Daylight Time	08/04/2014 10:31:29 AM Eastern Daylight Time	07/31/2014 04:11:20 PM Eastern Daylight Time			08/06/2014 02:41:21 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H9190	010	0	2015	North Carolina Counties		2	200	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	011	0	1	01	01	H9190_011_0	7		1	07/24/2014	2015.01	07/24/2014 12:17:02 PM Eastern Daylight Time	08/04/2014 10:31:48 AM Eastern Daylight Time	07/31/2014 04:11:30 PM Eastern Daylight Time			08/06/2014 02:43:15 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Choice (HMO)	01	01		1			H9190	011	0	2015	North Carolina Counties		2	150	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	012	0	1	01	01	H9190_012_0	6		1	07/22/2014	2015.01	07/22/2014 02:09:07 PM Eastern Daylight Time	08/04/2014 10:32:05 AM Eastern Daylight Time	07/31/2014 04:11:40 PM Eastern Daylight Time			08/06/2014 02:45:18 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Prime (HMO)	01	01		1			H9190	012	0	2015	North Carolina Counties		2	150	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	013	0	1	01	01	H9190_013_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:50:49 AM Eastern Daylight Time	08/04/2014 11:11:41 AM Eastern Daylight Time	07/31/2014 04:11:49 PM Eastern Daylight Time			08/06/2014 02:49:42 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Diamond (HMO SNP)	01	01		1			H9190	013	0	2015	Kentucky Counties		2	300	2			1	3		1	5			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	014	0	1	01	01	H9190_014_0	7	2	1	08/05/2014	2015.01	08/05/2014 11:51:35 AM Eastern Daylight Time	08/04/2014 10:32:41 AM Eastern Daylight Time	07/31/2014 04:11:58 PM Eastern Daylight Time			08/06/2014 02:53:51 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Ruby (HMO SNP)	01	01		1			H9190	014	0	2015	Kentucky Counties		2	200	2			1	3		1	4			www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	015	0	1	01	01	H9190_015_0	7		1	07/24/2014	2015.01	07/24/2014 12:20:57 PM Eastern Daylight Time	08/04/2014 10:32:59 AM Eastern Daylight Time	07/31/2014 04:12:32 PM Eastern Daylight Time			08/06/2014 02:55:59 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Gold (HMO SNP)	01	01		1			H9190	015	0	2015	Kentucky Counties		2	100	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	016	0	1	01	01	H9190_016_0	7		1	07/24/2014	2015.01	07/24/2014 12:21:06 PM Eastern Daylight Time	08/04/2014 10:33:18 AM Eastern Daylight Time	07/31/2014 04:12:41 PM Eastern Daylight Time			08/06/2014 02:59:16 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Platinum (HMO SNP)	01	01		1			H9190	016	0	2015	Kentucky Counties		2	150	2			1	4		1		00000000000000000010		www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	017	0	1	01	01	H9190_017_0	7		1	07/24/2014	2015.01	07/24/2014 12:21:16 PM Eastern Daylight Time	08/04/2014 10:33:37 AM Eastern Daylight Time	07/31/2014 04:12:50 PM Eastern Daylight Time			08/06/2014 03:01:22 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Choice (HMO)	01	01		1			H9190	017	0	2015	Kentucky Counties		2	150	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	018	0	1	01	01	H9190_018_0	7		1	07/24/2014	2015.01	07/24/2014 12:21:25 PM Eastern Daylight Time	08/04/2014 10:33:55 AM Eastern Daylight Time	07/31/2014 04:12:59 PM Eastern Daylight Time			08/06/2014 03:03:57 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Prime (HMO)	01	01		1			H9190	018	0	2015	Kentucky Counties		2	200	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	019	0	1	01	01	H9190_019_0	7		1	08/05/2014	2015.01	08/05/2014 12:01:20 PM Eastern Daylight Time	08/04/2014 10:34:12 AM Eastern Daylight Time	07/31/2014 04:13:08 PM Eastern Daylight Time			08/06/2014 03:06:17 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Standard (HMO)	01	01		1			H9190	019	0	2015	Ohio Counties		2	300	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	020	0	1	01	01	H9190_020_0	7		1	08/05/2014	2015.01	08/05/2014 12:02:21 PM Eastern Daylight Time	08/04/2014 10:34:30 AM Eastern Daylight Time	07/31/2014 04:13:17 PM Eastern Daylight Time			08/06/2014 03:08:55 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Standard (HMO)	01	01		1			H9190	020	0	2015	North Carolina Counties		2	250	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	021	0	1	01	01	H9190_021_0	7		1	08/05/2014	2015.01	08/05/2014 12:03:42 PM Eastern Daylight Time	08/04/2014 10:34:48 AM Eastern Daylight Time	07/31/2014 04:13:26 PM Eastern Daylight Time			08/06/2014 03:10:51 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.medicareassured.com	Gateway Health Medicare Assured Standard (HMO)	01	01		1			H9190	021	0	2015	Kentucky Counties		2	250	2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9190	801	0	1	01	01	H9190_801_0	4		1	05/27/2014	2015.01	05/27/2014 09:04:54 AM Eastern Daylight Time	06/02/2014 03:21:05 PM Eastern Daylight Time				07/22/2014 04:10:44 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.MedicareAssured.com	Gateway Health Medicare Assured Flex (HMO)	01	01		1			H9190	801	0	2015	Kentucky, North Carolina and Ohio counties		1		2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111110100111000011011100010100	2		1					1
H9190	802	0	1	01	01	H9190_802_0	4		1	05/27/2014	2015.01	05/27/2014 09:06:07 AM Eastern Daylight Time	06/02/2014 03:21:21 PM Eastern Daylight Time				07/22/2014 04:12:19 PM Eastern Daylight Time	GATEWAY HEALTH PLAN OF OHIO, INC.	Gateway Health Medicare Assured	www.MedicareAssured.com	Gateway Health Medicare Assured Flex (HMO)	01	01		1			H9190	802	0	2015	Kentucky, North Carolina and Ohio counties		1		2			2							www.MedicareAssured.com	www.MedicareAssured.com	www.MedicareAssured.com	(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(888)447-4505		(412)255-1323		(877)935-2168		(412)255-1193		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111110100111000011011100010100	2		1					1
H9207	001	0	1	01	01	H9207_001_0	7		1	07/21/2014	2015.01	07/21/2014 08:19:46 AM Eastern Daylight Time	06/02/2014 06:09:39 PM Eastern Daylight Time				07/21/2014 03:46:18 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Basic (HMO)	01	01		1			H9207	001	0	2015	Philadelphia County		2	636	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000										(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579										2					2					2
H9207	002	0	1	01	01	H9207_002_0	8		1	08/06/2014	2015.01	08/06/2014 05:12:27 PM Eastern Daylight Time	08/06/2014 05:36:50 PM Eastern Daylight Time	08/06/2014 05:36:50 PM Eastern Daylight Time			08/06/2014 05:48:33 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Prime (HMO)	01	01		1			H9207	002	0	2015	Philadelphia County		2	32820	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		2					2					2
H9207	003	0	1	01	01	H9207_003_0	8		1	08/06/2014	2015.01	08/06/2014 05:19:33 PM Eastern Daylight Time	08/06/2014 05:36:50 PM Eastern Daylight Time	08/06/2014 05:36:50 PM Eastern Daylight Time			08/06/2014 05:48:33 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare PrimePlus (HMO)	01	01		1			H9207	003	0	2015	Philadelphia County		2	6216	2			2							HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		2					2					2
H9207	004	0	1	01	01	H9207_004_0	9	2	1	08/06/2014	2015.01	08/06/2014 05:20:50 PM Eastern Daylight Time	08/06/2014 05:36:50 PM Eastern Daylight Time	08/06/2014 05:36:50 PM Eastern Daylight Time			08/06/2014 05:48:33 PM Eastern Daylight Time	HEALTH PARTNERS PLANS, INC.	Health Partners Medicare	HPPMedicare.com	Health Partners Medicare Special (HMO SNP)	01	01		1			H9207	004	0	2015	Philadelphia County		2	80838	2			1	3		1	2			HPPMedicare.com	HPPMedicare.com	HPPMedicare.com	(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(866)901-8000		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		(877)454-8477		(215)849-1579		2					2					2
H9208	001	0	1	01	01	H9208_001_0	12		1	08/05/2014	2015.02	08/05/2014 05:06:26 PM Pacific Daylight Time	08/06/2014 07:52:02 AM Pacific Daylight Time	07/31/2014 04:38:28 PM Pacific Daylight Time			08/06/2014 02:22:46 PM Pacific Daylight Time	RIVERLINK HEALTH	RiverLink Health	www.riverlinkhealth.com	Classic Plus Rx (HMO)	01	01		1			H9208	001	0	2015	Butler, Clermont, Hamilton and Warren Counties		2	2500	2			2							www.riverlinkhealth.com	www.riverlinkhealth.com	www.riverlinkhealth.com	(866)329-3970		(253)345-5545		(866)329-3970		(253)345-5545		(866)329-3970		(253)345-5545		(866)329-3970		(253)345-5545		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9208	002	0	1	01	01	H9208_002_0	12		1	08/05/2014	2015.02	08/05/2014 05:07:04 PM Pacific Daylight Time	08/06/2014 08:00:12 AM Pacific Daylight Time	07/31/2014 04:38:28 PM Pacific Daylight Time			08/06/2014 02:22:46 PM Pacific Daylight Time	RIVERLINK HEALTH	RiverLink Health	www.riverlinkhealth.com	Classic Plus Rx - N Kentucky (HMO)	01	01		1			H9208	002	0	2015	Boone, Campbell and Kenton Counties		2	1000	2			2							www.riverlinkhealth.com	www.riverlinkhealth.com	www.riverlinkhealth.com	(866)329-3970		(253)345-5545		(866)329-3970		(253)345-5545		(866)329-3970		(253)345-5545		(866)329-3970		(253)345-5545		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9264	001	0	1	48	05	H9264_001_0	4		1	06/30/2014	2015.01	06/30/2014 10:02:36 AM Pacific Daylight Time					06/30/2014 10:28:09 AM Pacific Daylight Time	ALAMEDA ALLIANCE JOINT POWERS AUTHORITY (JPA)	Alliance CompleteCare Plus	www.alamedaalliance.org	Alliance CompleteCare Plus (Medicare-Medicaid Plan)	05	48		1			H9264	001	0	2015	Alameda		2	11969	2			2							www.alamedaalliance.org	www.alamedaalliance.org	www.alamedaalliance.org	(877)585-7526		(510)747-4560		(877)585-7526		(510)747-4560		(877)585-7526		(510)747-4560		(877)585-7526		(510)747-4560		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		(800)735-2929		(711)-		2					2					2
H9266	001	0	1	20	08	H9266_001_0	1		1	05/28/2014	2015.01	05/28/2014 01:32:12 PM Eastern Daylight Time		05/28/2014 12:04:25 PM Eastern Daylight Time			05/28/2014 01:33:25 PM Eastern Daylight Time	PIEDMONT HEALTH SERVICES, INC.	Piedmont Health SeniorCare	http://www.piedmonthealthseniorcare.org/	Piedmont Health SeniorCare - Dual (PACE)	08	20		1			H9266	001	0	2015	Piedmont Region of NC		2		2			2								no answer	no answer									(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000										(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000												
H9266	003	0	1	20	08	H9266_003_0	1		1	05/28/2014	2015.01	05/28/2014 01:32:24 PM Eastern Daylight Time		05/28/2014 12:10:27 PM Eastern Daylight Time			05/28/2014 01:33:25 PM Eastern Daylight Time	PIEDMONT HEALTH SERVICES, INC.	Piedmont Health SeniorCare	http://www.piedmonthealthseniorcare.org/	Piedmont Health SeniorCare - Medicare only (PACE)	08	20		1			H9266	003	0	2015	Piedmont Region of NC		2		2			2								no answer	no answer									(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000										(877)714-2100		(336)532-0000		(877)714-2100		(336)532-0000												
H9285	001	0	1	01	01	H9285_001_0	8		1	07/18/2014	2015.01	07/18/2014 01:19:06 PM Eastern Daylight Time	08/04/2014 05:05:53 PM Eastern Daylight Time	08/04/2014 04:56:22 PM Eastern Daylight Time			08/05/2014 08:32:58 AM Eastern Daylight Time	ATLANTIS HEALTH PLAN, INC.	EASY CHOICE HEALTH PLAN OF NEW YORK	www.EasyChoiceNY.com	Easy Choice Rewards (HMO)	01	01		1			H9285	001	0	2015	Select Counties in New York		2	1	2			2							www.EasyChoiceNY.com	www.EasyChoiceNY.com	www.EasyChoiceNY.com	(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H9285	003	0	1	01	01	H9285_003_0	9		1	08/05/2014	2015.01	08/05/2014 08:30:40 AM Eastern Daylight Time	08/04/2014 05:02:41 PM Eastern Daylight Time	08/04/2014 04:55:04 PM Eastern Daylight Time			08/05/2014 08:32:58 AM Eastern Daylight Time	ATLANTIS HEALTH PLAN, INC.	EASY CHOICE HEALTH PLAN OF NEW YORK	www.EasyChoiceNY.com	Easy Choice Diamond Rewards (HMO SNP)	01	01		1			H9285	003	0	2015	Select Counties in New York		2	1	2			1	4		1		00000000000000000010		www.EasyChoiceNY.com	www.EasyChoiceNY.com	www.EasyChoiceNY.com	(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(888)300-9320		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H9302	003	0	1	01	01	H9302_003_0	11		1	07/21/2014	2015.02	07/21/2014 11:51:31 AM Pacific Daylight Time	08/06/2014 08:50:06 AM Pacific Daylight Time	07/31/2014 04:38:30 PM Pacific Daylight Time			08/06/2014 02:34:31 PM Pacific Daylight Time	SOUNDPATH HEALTH, INC.	Soundpath Health	www.soundpathhealth.com	Soundpath Health Charter + Rx (HMO)	01	01		1			H9302	003	0	2015	Western and Central Washington areas		2	3300	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9302	004	0	1	01	01	H9302_004_0	7		1	07/21/2014	2015.02	07/21/2014 11:51:47 AM Pacific Daylight Time	06/01/2014 11:56:24 PM Pacific Daylight Time				07/22/2014 10:38:38 AM Pacific Daylight Time	SOUNDPATH HEALTH, INC.	Soundpath Health	www.soundpathhealth.com	Soundpath Health Alpine (HMO)	01	01		1			H9302	004	0	2015	Western and Central Washington areas		2	1269	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830										(711)-		(711)-		(711)-		(711)-										2					2					2
H9302	007	0	1	01	01	H9302_007_0	11		1	07/21/2014	2015.02	07/21/2014 11:52:10 AM Pacific Daylight Time	08/06/2014 08:49:16 AM Pacific Daylight Time	07/31/2014 04:38:30 PM Pacific Daylight Time			08/06/2014 02:36:21 PM Pacific Daylight Time	SOUNDPATH HEALTH, INC.	Soundpath Health	www.soundpathhealth.com	Soundpath Health Sound + Rx (HMO)	01	01		1			H9302	007	0	2015	Western Washington areas		2	11741	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9302	011	0	1	01	01	H9302_011_0	11		1	08/06/2014	2015.02	08/06/2014 09:59:48 AM Pacific Daylight Time	08/06/2014 11:37:16 AM Pacific Daylight Time	07/31/2014 04:38:30 PM Pacific Daylight Time			08/06/2014 02:39:44 PM Pacific Daylight Time	SOUNDPATH HEALTH, INC.	Soundpath Health	www.soundpathhealth.com	Soundpath Health Peak + Rx (HMO)	01	01		1			H9302	011	0	2015	Western and Central Washington areas		2	2200	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9302	801	0	1	01	01	H9302_801_0	3		1	05/31/2014	2015.02	05/31/2014 06:05:27 PM Pacific Daylight Time	06/01/2014 11:23:02 PM Pacific Daylight Time				06/02/2014 01:10:47 AM Pacific Daylight Time	SOUNDPATH HEALTH, INC.	Soundpath Health	www.soundpathhealth.com.	Soundpath Health + Rx (HMO)	01	01		1			H9302	801	0	2015	Western and Central Washington areas		1	9	2			2							http://www.soundpathhealth.com	www.soundpathhealth.com	www.soundpathhealth.com	(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(866)789-7747		(253)779-8830		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9323	001	0	1	20	08	H9323_001_0	1		1	10/30/2014	2015.03	10/30/2014 03:52:18 PM Mountain Daylight Time		10/16/2014 09:07:43 AM Mountain Daylight Time			10/30/2014 04:09:27 PM Mountain Daylight Time	BEACON HEALTH AND SOCIAL SERVICES, INC.	Beacon of LIFE	http://www.acutecarehs.com/	Beacon Health and Social Services, Inc (PACE)	08	20		1			H9323	001	0	2015	Monmouth County		2		2			2								NA	NA									(800)000-0000		(732)806-3219		(800)000-0000		(732)806-3219										(800)000-0000		(732)806-3219		(800)000-0000		(732)806-3219												
H9323	002	0	1	20	08	H9323_002_0	1		1	10/30/2014	2015.03	10/30/2014 03:52:36 PM Mountain Daylight Time		10/16/2014 09:15:48 AM Mountain Daylight Time			10/30/2014 04:09:27 PM Mountain Daylight Time	BEACON HEALTH AND SOCIAL SERVICES, INC.	Beacon of LIFE	http://www.acutecarehs.com/	Beacon Health and Social Services, Inc (PACE)	08	20		1			H9323	002	0	2015	Monmouth County		2		2			2								NA	NA									(800)000-0000		(732)806-3219		(800)000-0000		(732)806-3219										(800)000-0000		(732)806-3219		(800)000-0000		(732)806-3219												
H9345	001	0	1	48	05	H9345_001_0	7		1	08/29/2014	2015.01	08/29/2014 10:47:09 AM Eastern Daylight Time					08/29/2014 10:47:40 AM Eastern Daylight Time	VILLAGE SENIOR SERVICES CORPORATION	VillageCareMAX Full Advantage FIDA	www.villagecaremax.org	VillageCareMAX Full Advantage FIDA (Medicare-Medicaid Plan)	05	48		1			H9345	001	0	2015	Kings, Queens, Bronx, New York		2	1908	2			2							www.villagecaremax.org	www.villagecaremax.org	www.villagecaremax.org	(800)469-6292		(800)469-6292		(800)469-6292		(800)469-6292		(888)807-6806		(888)807-6806		(800)469-6292		(800)469-6292		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9385	002	0	1	01	01	H9385_002_0	9		1	08/05/2014	2015.01	08/05/2014 07:24:18 PM Pacific Daylight Time	08/05/2014 03:13:11 PM Pacific Daylight Time	07/31/2014 02:01:12 PM Pacific Daylight Time			08/06/2014 04:42:29 PM Pacific Daylight Time	SCAN HEALTH PLAN ARIZONA	SCAN Health Plan Arizona	www.scanhealthplan.com	SCAN Classic (HMO)	01	01		1			H9385	002	0	2015	Maricopa and Pima Counties		2		2			2							www.scanhealthplan.com	www.scanhealthplan.com	www.scanhealthplan.com	(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396		(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9385	805	0	1	01	01	H9385_805_0	3		1	05/20/2014	2015.01	05/20/2014 03:05:05 PM Pacific Daylight Time	07/18/2014 12:06:17 PM Pacific Daylight Time				07/18/2014 02:10:13 PM Pacific Daylight Time	SCAN HEALTH PLAN ARIZONA	SCAN Health Plan Arizona	www.scanhealthplan.com	SCAN Arizona Employer Group (HMO)	01	01		1			H9385	805	0	2015	Maricopa County		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396										(711)-		(711)-		(711)-		(711)-										2					2					2
H9385	807	0	1	01	01	H9385_807_0	3		1	05/20/2014	2015.01	05/20/2014 03:05:21 PM Pacific Daylight Time	07/18/2014 12:10:23 PM Pacific Daylight Time				07/18/2014 02:10:13 PM Pacific Daylight Time	SCAN HEALTH PLAN ARIZONA	SCAN Health Plan Arizona	www.scanhealthplan.com	SCAN Arizona Employer Group (HMO)	01	01		1			H9385	807	0	2015	Maricopa County		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396		(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9385	808	0	1	01	01	H9385_808_0	3		1	05/20/2014	2015.01	05/20/2014 03:05:34 PM Pacific Daylight Time	07/18/2014 12:13:10 PM Pacific Daylight Time				07/18/2014 02:10:13 PM Pacific Daylight Time	SCAN HEALTH PLAN ARIZONA	SCAN Health Plan Arizona	www.scanhealthplan.com	SCAN Arizona Employer Group (HMO)	01	01		1			H9385	808	0	2015	Maricopa County		1		2			2							www.scanhealthplan.com	http://www.scanhealthplan.com	http://www.scanhealthplan.com	(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396		(888)540-7226		(888)540-7226		(866)563-7396		(866)563-7396		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9412	003	0	1	04	01	H9412_003_0	7		1	07/11/2014	2015.02	07/11/2014 04:39:00 PM Eastern Daylight Time	08/05/2014 05:16:16 PM Eastern Daylight Time	08/05/2014 01:14:58 PM Eastern Daylight Time			08/06/2014 06:45:19 PM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Preferred Rx (PPO)	01	04		1			H9412	003	0	2015	Monmouth and Ocean Counties, New Jersey		2		2			2							www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376		(800)988-4861		(570)271-8771		(800)419-1376		(800)419-1376		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9412	801	0	1	04	01	H9412_801_0	6		1	07/01/2014	2015.02	07/01/2014 02:37:16 PM Eastern Daylight Time	06/23/2014 01:03:58 PM Eastern Daylight Time				07/01/2014 04:03:17 PM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Preferred 100 (Employer Group) (PPO)	01	04		1			H9412	801	0	2015	Geisinger Gold Preferred 100		1		2			2							www.MeridianGeisingerGold.com	https://www.thehealthplan.com/Gold/Landing_Pages/Formulary/	www.geisingergold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376										(711)-		(711)-		(711)-		(711)-										1	1	011111110010100111110001011110000110	2		1					
H9412	802	0	1	04	01	H9412_802_0	6		1	07/01/2014	2015.02	07/01/2014 02:37:39 PM Eastern Daylight Time	06/23/2014 01:04:46 PM Eastern Daylight Time				07/01/2014 04:03:17 PM Eastern Daylight Time	GEISINGER QUALITY OPTIONS, INC.	Geisinger Gold	www.MeridianGeisingerGold.com	Geisinger Gold Preferred 100 Rx (Employer Group) (PPO)	01	04		1			H9412	802	0	2015	New Jersey		1		2			2							www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	www.MeridianGeisingerGold.com	(800)498-9731		(570)271-8771		(800)419-1376		(800)419-1376		(800)988-4861		(570)271-8771		(800)419-1376		(800)419-1376		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111110010100111110001011110000110	2		1					
H9487	001	0	1	48	05	H9487_001_0	5		1	09/23/2014	2015.01	09/23/2014 06:25:21 PM Central Daylight Time					09/23/2014 06:26:56 PM Central Daylight Time	FIDELIS SECURECARE OF MICHIGAN	Fidelis SecureCare of Michigan	www.fidelissc.com	Fidelis SecureLife (Medicare-Medicaid Plan)	05	48		1			H9487	001	0	2015	Selected Michigan Counties		2	15000	2			2							www.fidelissc.com	www.fidelissc.com	www.fidelissc.com	(877)372-8085		(877)372-8085		(855)402-4791		(313)870-9600		(866)832-9245		(866)832-9245		(855)402-4791		(313)870-9600		(711)-		(711)-		(711)-		(711)-		(800)716-3231		(800)716-3231		(711)-		(711)-		2					2					2
H9492	001	0	1	01	01	H9492_001_0	11		1	08/05/2014	2015.02	08/05/2014 05:08:50 PM Pacific Daylight Time	08/06/2014 07:47:52 AM Pacific Daylight Time	07/31/2014 04:38:30 PM Pacific Daylight Time			08/06/2014 02:41:03 PM Pacific Daylight Time	STABLEVIEW HEALTH	StableView Health	www.stableviewhealth.com	Classic Plus Rx (HMO)	01	01		1			H9492	001	0	2015	Lexington Metropolitan Area		2	2500	2			2							www.stableviewhealth.com	www.stableviewhealth.com	www.stableviewhealth.com	(866)792-0180		(253)345-5552		(866)792-0180		(253)345-5552		(866)792-0180		(253)345-5552		(866)792-0180		(253)345-5552		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9525	003	0	1	01	01	H9525_003_0	12	2	1	08/05/2014	2015.01	08/05/2014 09:11:48 AM Eastern Daylight Time	08/06/2014 02:29:26 PM Eastern Daylight Time	08/06/2014 04:06:49 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H9525	003	0	2015	Wisconsin		2	100	2			1	3		1	5				www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9525	004	0	1	01	01	H9525_004_0	11		1	07/11/2014	2015.01	07/11/2014 02:49:28 PM Central Daylight Time	08/06/2014 02:53:55 AM Eastern Daylight Time	08/01/2014 05:31:24 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H9525	004	0	2015	Milwaukee and Waukesha		2	484	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9525	005	0	1	01	01	H9525_005_0	11		1	07/01/2014	2015.01	07/01/2014 10:00:47 AM Central Daylight Time	08/06/2014 02:53:59 AM Eastern Daylight Time	08/01/2014 05:31:25 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H9525	005	0	2015	Kenosha		2	209	2			2								www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9525	801	0	1	01	01	H9525_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:40:21 AM Pacific Daylight Time	07/15/2014 01:25:26 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	801	0	2015	Wisconsin select counties		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H9525	802	0	1	01	01	H9525_802_0	8		1	05/31/2014	2015.01	05/31/2014 11:41:06 AM Pacific Daylight Time	07/15/2014 01:25:31 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9525	802	0	2015	Select counties in Wisconsin		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)320-6557		(855)320-6557		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H9572	001	1	1	04	01	H9572_001_1	11		1	07/25/2014	2015.01	07/25/2014 04:28:48 AM Eastern Daylight Time	08/05/2014 05:52:31 PM Eastern Daylight Time	08/04/2014 12:29:11 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	1	2015	State of Michigan	Region 1	2	1679	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	001	2	1	04	01	H9572_001_2	11		1	07/25/2014	2015.01	07/25/2014 04:35:17 AM Eastern Daylight Time	08/05/2014 05:59:37 PM Eastern Daylight Time	08/04/2014 12:29:20 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	2	2015	State of Michigan	Region 2	2	4394	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	001	3	1	04	01	H9572_001_3	11		1	07/25/2014	2015.01	07/25/2014 04:36:11 AM Eastern Daylight Time	08/05/2014 06:03:27 PM Eastern Daylight Time	08/04/2014 12:29:30 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	3	2015	State of Michigan	Region 3	2	4236	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	001	4	1	04	01	H9572_001_4	11		1	07/25/2014	2015.01	07/25/2014 04:37:06 AM Eastern Daylight Time	08/05/2014 06:06:59 PM Eastern Daylight Time	08/04/2014 12:29:39 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	4	2015	State of Michigan	Region 4	2	7383	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	001	6	1	04	01	H9572_001_6	11		1	07/25/2014	2015.01	07/25/2014 04:37:56 AM Eastern Daylight Time	08/05/2014 06:10:48 PM Eastern Daylight Time	08/04/2014 12:29:48 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Signature (PPO)	01	04		1			H9572	001	6	2015	State of Michigan	Region 6	2	22938	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	002	1	1	04	01	H9572_002_1	12		1	07/25/2014	2015.01	07/25/2014 04:28:19 AM Eastern Daylight Time	08/05/2014 06:17:29 PM Eastern Daylight Time	08/04/2014 12:29:57 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	1	2015	State of Michigan	Region 1	2	531	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	002	2	1	04	01	H9572_002_2	11		1	07/25/2014	2015.01	07/25/2014 04:39:01 AM Eastern Daylight Time	08/05/2014 06:21:35 PM Eastern Daylight Time	08/04/2014 12:30:07 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	2	2015	State of Michigan	Region 2	2	1540	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	002	3	1	04	01	H9572_002_3	11		1	07/25/2014	2015.01	07/25/2014 04:40:57 AM Eastern Daylight Time	08/05/2014 06:25:37 PM Eastern Daylight Time	08/04/2014 12:30:17 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	3	2015	State of Michigan	Region 3	2	1186	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	002	4	1	04	01	H9572_002_4	11		1	07/25/2014	2015.01	07/25/2014 04:41:50 AM Eastern Daylight Time	08/05/2014 06:29:54 PM Eastern Daylight Time	08/04/2014 12:30:26 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	4	2015	State of Michigan	Region 4	2	2231	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	002	6	1	04	01	H9572_002_6	11		1	07/25/2014	2015.01	07/25/2014 04:42:44 AM Eastern Daylight Time	08/05/2014 06:37:32 PM Eastern Daylight Time	08/04/2014 12:30:36 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Vitality (PPO)	01	04		1			H9572	002	6	2015	State of Michigan	Region 6	2	2591	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	003	1	1	04	01	H9572_003_1	11		1	07/25/2014	2015.01	07/25/2014 03:35:12 AM Eastern Daylight Time	08/05/2014 04:11:28 PM Eastern Daylight Time	08/04/2014 12:36:42 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	1	2015	State of Michigan	Region 1	2	1158	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	003	2	1	04	01	H9572_003_2	11		1	07/25/2014	2015.01	07/25/2014 04:43:33 AM Eastern Daylight Time	08/05/2014 04:11:38 PM Eastern Daylight Time	08/04/2014 12:31:55 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	2	2015	State of Michigan	Region 2	2	1316	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	003	3	1	04	01	H9572_003_3	11		1	07/25/2014	2015.01	07/25/2014 04:44:28 AM Eastern Daylight Time	08/05/2014 04:11:48 PM Eastern Daylight Time	08/04/2014 12:32:04 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	3	2015	State of Michigan	Region 3	2	1316	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	003	4	1	04	01	H9572_003_4	11		1	07/25/2014	2015.01	07/25/2014 04:45:25 AM Eastern Daylight Time	08/05/2014 04:09:45 PM Eastern Daylight Time	08/04/2014 12:32:13 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	4	2015	State of Michigan	Region 4	2	3413	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	003	6	1	04	01	H9572_003_6	11		1	07/25/2014	2015.01	07/25/2014 04:46:40 AM Eastern Daylight Time	08/05/2014 04:09:55 PM Eastern Daylight Time	08/04/2014 12:32:22 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Assure (PPO)	01	04		1			H9572	003	6	2015	State of Michigan	Region 6	2	6791	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	004	1	1	04	01	H9572_004_1	11		1	07/25/2014	2015.01	07/25/2014 03:35:40 AM Eastern Daylight Time	08/05/2014 06:44:56 PM Eastern Daylight Time	08/04/2014 12:32:32 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	1	2015	State of Michigan	Region 1	2	183	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	004	2	1	04	01	H9572_004_2	11		1	07/25/2014	2015.01	07/25/2014 04:47:31 AM Eastern Daylight Time	08/05/2014 06:50:05 PM Eastern Daylight Time	08/04/2014 12:32:42 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	2	2015	State of Michigan	Region 2	2	531	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	004	3	1	04	01	H9572_004_3	11		1	07/25/2014	2015.01	07/25/2014 04:48:31 AM Eastern Daylight Time	08/05/2014 07:13:11 PM Eastern Daylight Time	08/04/2014 12:32:53 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	3	2015	State of Michigan	Region 3	2	409	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	004	4	1	04	01	H9572_004_4	11		1	07/25/2014	2015.01	07/25/2014 04:49:24 AM Eastern Daylight Time	08/05/2014 07:06:06 PM Eastern Daylight Time	08/04/2014 12:33:03 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	4	2015	State of Michigan	Region 4	2	739	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	004	6	1	04	01	H9572_004_6	12		1	07/25/2014	2015.01	07/25/2014 04:50:25 AM Eastern Daylight Time	08/05/2014 07:01:21 PM Eastern Daylight Time	08/04/2014 12:33:13 PM Eastern Daylight Time			08/06/2014 10:28:59 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Essential (PPO)	01	04		1			H9572	004	6	2015	State of Michigan	Region 6	2	893	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9572	801	0	1	04	01	H9572_801_0	9		1	05/30/2014	2015.01	05/30/2014 12:37:26 PM Eastern Daylight Time	06/04/2014 02:55:49 PM Eastern Daylight Time				06/09/2014 10:50:53 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer Rx CY (PPO)	01	04		1			H9572	801	0	2015	State of Michigan		1	12000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100001110001000000000000	2		1					
H9572	802	0	1	04	01	H9572_802_0	9		1	05/30/2014	2015.01	05/30/2014 12:37:41 PM Eastern Daylight Time	06/04/2014 03:00:54 PM Eastern Daylight Time				06/09/2014 10:50:53 AM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer CY (PPO)	01	04		1			H9572	802	0	2015	State of Michigan		1	120000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100001110001000000000000	2		1					
H9572	803	0	1	04	01	H9572_803_0	8		1	05/30/2014	2015.01	05/30/2014 12:37:53 PM Eastern Daylight Time	06/02/2014 12:39:06 PM Eastern Daylight Time				06/02/2014 08:14:02 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer Rx non-CY (PPO)	01	04		1			H9572	803	0	2015	State of Michigan		1	12000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307		(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111000100001110001000000000000	2		1					
H9572	804	0	1	04	01	H9572_804_0	8		1	05/30/2014	2015.01	05/30/2014 12:38:06 PM Eastern Daylight Time	06/02/2014 12:39:41 PM Eastern Daylight Time				06/02/2014 08:14:02 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Medicare Plus Blue PPO Employer non-CY (PPO)	01	04		1			H9572	804	0	2015	State of Michigan		1	12000	2			2							www.bcbsm.com/providersmedicare	www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare	(877)241-2583		(877)241-2583		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-										1	1	011111111000100001110001000000000000	2		1					
H9592	001	0	1	20	08	H9592_001_0	1		1	08/21/2014	2015.01	08/21/2014 08:38:21 AM Pacific Daylight Time		08/18/2014 07:43:17 AM Pacific Daylight Time			08/21/2014 08:40:06 AM Pacific Daylight Time	CENTRAL VALLEY MEDICAL SERVICES CORPORATION	Fresno PACE	www.fresnopace.org	Central Valley Medical Services Dual Eligible (PACE)	08	20		1			H9592	001	0	2015	Fresno County Area		2		2			2								www.pharmastarpbm.com/	www.fresnopace.org									(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223												
H9592	002	0	1	20	08	H9592_002_0	1		1	08/21/2014	2015.01	08/21/2014 08:38:53 AM Pacific Daylight Time		08/18/2014 07:52:12 AM Pacific Daylight Time			08/21/2014 08:40:06 AM Pacific Daylight Time	CENTRAL VALLEY MEDICAL SERVICES CORPORATION	Fresno PACE	www.fresnopace.org	Central Valley Medical Services Medicare only (PACE)	08	20		1			H9592	002	0	2015	Fresno County Area		2		2			2								www.pharmastarpbm.com/	www.fresnopace.org									(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223										(855)630-7223		(855)630-7223		(855)630-7223		(855)630-7223												
H9615	007	0	1	04	01	H9615_007_0	7		1	07/24/2014	2015.01	07/24/2014 09:11:03 PM Eastern Daylight Time	06/30/2014 02:56:39 PM Eastern Daylight Time	05/31/2014 03:30:51 PM Eastern Daylight Time			07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Gold PPO with Part D (PPO)	01	04		1			H9615	007	0	2015	Western NY, Central NY, Eastern NY, Western VT		2	3922	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					
H9615	008	0	1	04	01	H9615_008_0	6		1	07/24/2014	2015.01	07/24/2014 09:11:10 PM Eastern Daylight Time	06/02/2014 11:05:17 AM Eastern Daylight Time	05/31/2014 03:31:01 PM Eastern Daylight Time			07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	BasiCare with Part D (PPO)	01	04		1			H9615	008	0	2015	Western NY, Central NY, Eastern NY, Western VT		2	633	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					
H9615	802	0	1	04	01	H9615_802_0	5		1	05/29/2014	2015.01	05/29/2014 01:19:17 PM Eastern Daylight Time	06/09/2014 07:36:12 AM Eastern Daylight Time				06/09/2014 08:08:29 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	GoldAnywhere Rx - Employer Group (PPO)	01	04		1			H9615	802	0	2015	Employer Group East/West		1	6676	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	011111111111111111111111111111111111	2		1					
H9615	807	0	1	04	01	H9615_807_0	3		1	06/05/2014	2015.01	06/05/2014 01:31:59 PM Eastern Daylight Time	06/09/2014 07:36:05 AM Eastern Daylight Time				06/09/2014 08:08:29 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	USA Care Rx - Employer Group (PPO)	01	04		1			H9615	807	0	2015	United States and Puerto Rico		1	650	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(888)597-4419		(888)597-4419		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	011111111111111111111111111111111111	2		1					
H9615	810	0	1	04	01	H9615_810_0	2		1	05/20/2014	2015.01	05/20/2014 01:08:48 PM Eastern Daylight Time	06/03/2014 12:41:43 AM Eastern Daylight Time				06/03/2014 12:45:00 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	GoldAnywhere - Employer Group (PPO)	01	04		1			H9615	810	0	2015	Western NY, Central NY, Eastern NY, Western VT		1	200	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	011111111111111111111111111111111111	2		1					
H9615	811	0	1	04	01	H9615_811_0	2		1	05/20/2014	2015.01	05/20/2014 01:10:19 PM Eastern Daylight Time	06/03/2014 12:41:51 AM Eastern Daylight Time				06/03/2014 12:50:12 AM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	USA Care - Employer Group (PPO)	01	04		1			H9615	811	0	2015	United States and Puerto Rico		1	100	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										1	1	011111111111111111111111111111111111	2		1					
H9685	001	0	1	01	01	H9685_001_0	10	2	1	08/12/2014	2015.01	08/12/2014 03:13:47 PM Pacific Daylight Time	08/06/2014 12:15:45 PM Pacific Daylight Time	08/06/2014 03:26:21 PM Pacific Daylight Time			08/12/2014 03:20:33 PM Pacific Daylight Time	MERCY MARICOPA INTEGRATED CARE	Mercy Maricopa Advantage	www.MercyMaricopaAdvantage.com	Mercy Maricopa Advantage (HMO SNP)	01	01		1			H9685	001	0	2015	Maricopa County		2	1540	2			1	3		1	4			www.MercyMaricopaAdvantage.com/members/mma/materials	www.MercyMaricopaAdvantage.com/members/mma/materials	www.MercyMaricopaAdvantage.com/members/mma/materials	(866)602-1979		(602)586-1880		(866)277-1025		(602)586-1843		(866)602-1979		(602)586-1880		(866)277-1025		(602)586-1843		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9689	001	0	1	01	01	H9689_001_0	3	2	1	08/05/2014	2015.01	08/05/2014 10:31:29 AM Central Daylight Time	08/05/2014 06:16:39 PM Central Daylight Time	07/31/2014 04:50:41 PM Central Daylight Time			08/06/2014 01:30:15 PM Central Daylight Time	HEALTH ALLIANCE CONNECT, INC.	Health Alliance Connect	healthalliancemedicare.org	Health Alliance Medicare (HMO SNP)	01	01		1			H9689	001	0	2015	Central IL		2	403	2			1	3		1	3		1	www.healthalliancemedicare.org	www.healthalliancemedicare.org	www.healthalliancemedicare.org	(877)642-3331		(877)642-3331		(877)642-3387		(877)642-3387		(877)642-3331		(877)642-3331		(877)642-3387		(877)642-3387		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844		2					1					1
H9699	001	0	1	01	01	H9699_001_0	12		1	08/14/2014	2015.01	08/14/2014 03:27:11 PM Central Daylight Time	08/14/2014 11:16:01 AM Central Daylight Time	08/01/2014 08:41:06 AM Central Daylight Time			08/14/2014 05:03:11 PM Central Daylight Time	HMO PARTNERS, INC.	Health Advantage	www.arkansasbluecross.com	Medi-Pak Advantage (HMO)	01	01		1			H9699	001	0	2015	Benton, Carroll, Madison and Washington counties		2	750	2			2							http://www.arkansasbluecross.com/lookingforinsurance/medicareplans/2014/default.aspx	http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com	(877)233-7022		(877)233-7022		(888)242-5017		(888)242-5017		(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869		2					2					2
H9712	001	0	1	48	05	H9712_001_0	5		1	10/07/2014	2015.01	10/07/2014 01:50:11 PM Eastern Daylight Time					10/07/2014 04:44:40 PM Eastern Daylight Time	HAP MIDWEST HEALTH PLAN, INC.	HAP Midwest MI Health Link	www.MidwestAdvantage.org	HAP Midwest MI Health Link (Medicare-Medicaid Plan)	05	48		1			H9712	001	0	2015	HAP Midwest MI Health Link		2	1000	2			2							www.MidwestAdvantage.org	www.MidwestAdvantage.org	www.MidwestAdvantage.org	(888)654-0706		(313)581-3700		(888)654-0706		(313)581-3700		(888)445-5580		(313)581-3700		(888)654-0706		(313)581-3700		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777		2					2					2
H9725	001	0	1	01	01	H9725_001_0	4		1	07/16/2014	2015.02	07/16/2014 02:38:32 PM Central Daylight Time	05/29/2014 07:21:45 PM Central Daylight Time	07/31/2014 03:47:03 PM Central Daylight Time			08/05/2014 09:32:50 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred (HMO)	01	01		1			H9725	001	0	2015	North Carolina		2		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9725	003	0	1	01	01	H9725_003_0	4	2	1	07/16/2014	2015.02	07/16/2014 02:38:45 PM Central Daylight Time	08/04/2014 01:27:44 PM Central Daylight Time	07/31/2014 03:47:13 PM Central Daylight Time			08/05/2014 09:32:50 AM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring TotalCare (HMO SNP)	01	01		1			H9725	003	0	2015	North Carolina		2		2			1	3		1	2			www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(800)668-3813		(800)668-3813		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9725	801	0	1	01	01	H9725_801_0	1		1	05/14/2014	2015.02	05/14/2014 10:18:45 AM Central Daylight Time	05/29/2014 07:22:25 PM Central Daylight Time				05/29/2014 11:35:16 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx CY (HMO)	01	01		1			H9725	801	0	2015	North Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H9725	802	0	1	02	01	H9725_802_0	1		1	05/14/2014	2015.02	05/14/2014 10:19:17 AM Central Daylight Time	05/29/2014 07:22:45 PM Central Daylight Time				05/29/2014 11:55:39 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx CY (HMO-POS)	01	02		1			H9725	802	0	2015	North Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H9725	803	0	1	01	01	H9725_803_0	1		1	05/14/2014	2015.02	05/14/2014 10:19:45 AM Central Daylight Time	05/29/2014 07:23:06 PM Central Daylight Time				05/29/2014 11:35:16 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred Rx FY (HMO)	01	01		1			H9725	803	0	2015	North Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H9725	804	0	1	02	01	H9725_804_0	1		1	05/14/2014	2015.02	05/14/2014 10:20:08 AM Central Daylight Time	05/29/2014 07:23:27 PM Central Daylight Time				05/29/2014 11:35:16 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Premier Rx FY (HMO-POS)	01	02		1			H9725	804	0	2015	North Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H9725	805	0	1	01	01	H9725_805_0	1		1	05/14/2014	2015.02	05/14/2014 10:20:28 AM Central Daylight Time	05/29/2014 07:23:48 PM Central Daylight Time				05/29/2014 11:35:16 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Preferred FY (HMO)	01	01		1			H9725	805	0	2015	North Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1					1
H9725	806	0	1	02	01	H9725_806_0	1		1	05/23/2014	2015.02	05/23/2014 09:36:30 AM Central Daylight Time	05/29/2014 07:24:08 PM Central Daylight Time				05/29/2014 11:35:16 PM Central Daylight Time	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Cigna-Healthspring	www.mycignahealthspring.com	Cigna-HealthSpring Premier FY (HMO-POS)	01	02		1			H9725	806	0	2015	North Carolina		1		2			2							www.mycignahealthspring.com	www.mycignahealthspring.com	www.mycignahealthspring.com	(888)281-7867		(888)281-7867		(866)593-4468		(866)593-4468										(711)-		(711)-		(711)-		(711)-										1	1	011111111011101111111111011101000110	1	110000111011011111110010110	1	1	011111111111111111111111111111111111	1	110000111011011111110010110	1
H9730	002	0	1	02	01	H9730_002_0	6		1	08/04/2014	2015.02	08/04/2014 01:15:13 PM Eastern Daylight Time	08/05/2014 11:34:21 AM Eastern Daylight Time	08/01/2014 11:36:59 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com	WellCare Value (HMO-POS)	01	02		1			H9730	002	0	2015	Louisville, Middletown, Lexington-Fayette		2	3474	2			2							www.wellcare.com	www.wellcare.com	www.wellcare.com	(877)560-3206		(877)560-3206		(877)817-5794		(877)817-5794		(877)560-3206		(877)560-3206		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H9730	003	0	1	01	01	H9730_003_0	4	2	1	05/31/2014	2015.02	05/31/2014 12:08:48 PM Eastern Daylight Time	08/05/2014 11:34:34 AM Eastern Daylight Time	08/01/2014 11:37:09 AM Eastern Daylight Time			08/06/2014 03:02:49 PM Eastern Daylight Time	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	WellCare	www.wellcare.com	Wellcare Access (HMO SNP)	01	01		1			H9730	003	0	2015	Louisville, Middletown, Lexington-Fayette		2	3568	2			1	3		1	5			www.wellcare.com	www.wellcare.com	www.wellcare.com	(877)560-2766		(877)560-2766		(877)817-5794		(877)817-5794		(877)560-2766		(877)560-2766		(877)817-5794		(877)817-5794		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		(877)247-6272		2					2					2
H9788	001	0	1	07	02	H9788_001_0	1		2	05/27/2014	2015.02	05/27/2014 11:38:37 AM Eastern Daylight Time			06/01/2014 08:41:51 AM Eastern Daylight Time		06/01/2014 08:59:52 AM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	ActiveSaver MSA or BlueSaver MSA	www.bcbswny.com/medicare	BlueSaver MSA (MSA)	02	07	2	1			H9788	001	0	2015	Western New York		2	768	2			2										(800)329-2792		(800)329-2792		(800)248-9296		(800)248-9296										(711)-		(711)-		(711)-		(711)-																				
H9788	002	0	1	07	02	H9788_002_0	1		2	05/27/2014	2015.02	05/27/2014 09:38:02 AM Eastern Daylight Time			06/01/2014 08:41:52 AM Eastern Daylight Time		06/01/2014 08:59:52 AM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	ActiveSaver MSA or BlueSaver MSA	www.bsneny.com/medicare	BlueSaver MSA (MSA)	02	07	2	1			H9788	002	0	2015	Northeastern New York		2	541	2			2										(800)329-2792		(800)329-2792		(877)258-7453		(877)258-7453										(711)-		(711)-		(711)-		(711)-																				
H9788	003	0	1	07	02	H9788_003_0	2		2	06/02/2014	2015.02	06/02/2014 11:14:43 AM Eastern Daylight Time			06/02/2014 11:08:20 AM Eastern Daylight Time		06/02/2014 11:15:20 AM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	ActiveSaver MSA or BlueSaver MSA	www.healthnowny.com/medicare	ActiveSaver MSA (MSA)	02	07	2	1			H9788	003	0	2015	Central New York		2	723	2			2										(800)329-2792		(800)329-2792		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																				
H9788	004	0	1	07	02	H9788_004_0	1		2	05/27/2014	2015.02	05/27/2014 09:37:55 AM Eastern Daylight Time			06/01/2014 08:41:52 AM Eastern Daylight Time		06/01/2014 08:59:52 AM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	ActiveSaver MSA or BlueSaver MSA	www.healthnowny.com/medicare	ActiveSaver MSA (MSA)	02	07	2	1			H9788	004	0	2015	Downstate New York		2	853	2			2										(800)329-2792		(800)329-2792		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-																				
H9788	801	0	1	07	02	H9788_801_0	2		2	05/27/2014	2015.02	05/27/2014 09:38:29 AM Eastern Daylight Time			06/03/2014 12:04:12 PM Eastern Daylight Time		06/03/2014 12:44:31 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	ActiveSaver MSA or BlueSaver MSA	www.bcbswny.com/www.bsneny.com/www.healthnowny.com	BlueSaver MSA (MSA)	02	07	2	1			H9788	801	0	2015	New York State		1	50	2			2										(888)787-2390		(888)787-2390		(855)215-9232		(855)215-9232										(711)-		(711)-		(711)-		(711)-																				
H9788	802	0	1	07	02	H9788_802_0	2		2	05/27/2014	2015.02	05/27/2014 09:38:42 AM Eastern Daylight Time			06/03/2014 12:04:12 PM Eastern Daylight Time		06/03/2014 12:44:31 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	ActiveSaver MSA or BlueSaver MSA	www.bcbswny.com/www.bsneny.com/www.healthnowny.com	ActiveSaver MSA (MSA)	02	07	2	1			H9788	802	0	2015	New York State		1	50	2			2										(888)787-2390		(888)787-2390		(855)215-9232		(855)215-9232										(711)-		(711)-		(711)-		(711)-																				
H9795	001	0	1	48	05	H9795_001_0	9		1	07/23/2014	2015.01	07/23/2014 03:19:28 PM Eastern Daylight Time					07/23/2014 03:21:28 PM Eastern Daylight Time	MONTEFIORE HMO, LLC	Montefiore Emerald Care FIDA Plan	www.montefiore.org/healthplans-medicare	Montefiore Emerald Care FIDA Plan (Medicare-Medicaid Plan)	05	48		1			H9795	001	0	2015	Bronx County		2	445	2			2							www.montefiore.org/healthplans-medicare	www.montefiore.org/healthplans-medicare	www.montefiore.org/healthplans-medicare	(855)266-8750		(855)266-8750		(855)526-6683		(855)526-6683		(855)266-8750		(855)266-8750		(855)526-6683		(855)526-6683		(711)-		(711)-		(711)-		(711)-		(866)236-1069		(866)236-1069		(711)-		(711)-		2					2					2
H9830	001	0	1	20	08	H9830_001_0	1		1	05/23/2014	2015.01	05/23/2014 10:04:01 AM Eastern Daylight Time		05/23/2014 09:58:45 AM Eastern Daylight Time			05/23/2014 10:07:05 AM Eastern Daylight Time	NEWCOURTLAND LIFE PROGRAM	NewCourtland LIFE Program	www.newcourtlandlife.org	NewCourtland LIFE  - Dual (PACE)	08	20		1			H9830	001	0	2015	NewCourtland LIFE - Dual		2		1	1		2								N/A	http://www.medicineshoppe.com/FranchiseeLocations/1024/SpecialServices.aspx									(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500										(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500												
H9830	002	0	1	20	08	H9830_002_0	1		1	05/23/2014	2015.01	05/23/2014 10:04:33 AM Eastern Daylight Time		05/23/2014 09:58:49 AM Eastern Daylight Time			05/23/2014 10:07:05 AM Eastern Daylight Time	NEWCOURTLAND LIFE PROGRAM	NewCourtland LIFE Program	www.newcourtlandlife.org	NewCourland LIFE - Medicare only (PACE)	08	20		1			H9830	002	0	2015	NewCourtland LIFE - Medicare only		2		1	1		2								N/A	http://www.medicineshoppe.com/FranchiseeLocations/1024/SpecialServices.aspx									(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500										(888)625-4334		(267)335-1500		(888)625-4334		(267)335-1500												
H9834	001	0	1	01	01	H9834_001_0	4		1	07/15/2014	2015.01	07/15/2014 01:32:09 PM Central Daylight Time	06/27/2014 02:31:17 PM Central Daylight Time	06/02/2014 09:48:17 AM Central Daylight Time			07/15/2014 01:53:34 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (w/Rx) (HMO)	01	01		1			H9834	001	0	2015	Counties: Fillmore, Houston, Winona		2	50	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2
H9834	003	0	1	01	01	H9834_003_0	3		1	07/15/2014	2015.01	07/15/2014 01:44:54 PM Central Daylight Time	06/01/2014 04:00:00 PM Central Daylight Time	06/02/2014 09:48:17 AM Central Daylight Time			07/15/2014 01:53:34 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (w/Rx) (HMO)	01	01		1			H9834	003	0	2015	Counties: Fillmore, Houston, Winona		2	632	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	http://www.gundersenhealthplan.org/PartDFormulary	http://www.gundersenhealthplan.org/providerdirectory	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		(800)877-8973		(711)-		2					2					2
H9834	004	0	1	01	01	H9834_004_0	4		1	07/15/2014	2015.01	07/15/2014 01:45:24 PM Central Daylight Time	07/03/2014 08:04:25 AM Central Daylight Time				07/15/2014 01:53:34 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Value (no Rx) (HMO)	01	01		1			H9834	004	0	2015	Counties: Fillmore, Houston, Winona		2	80	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2
H9834	005	0	1	01	01	H9834_005_0	4		1	07/15/2014	2015.01	07/15/2014 01:33:06 PM Central Daylight Time	07/03/2014 08:04:43 AM Central Daylight Time				07/15/2014 01:53:34 PM Central Daylight Time	GUNDERSEN HEALTH PLAN OF MINNESOTA	Gundersen Health Plan Minnesota	www.seniorpreferred.org	Gundersen MN Senior Preferred Elite (no Rx) (HMO)	01	01		1			H9834	005	0	2015	Counties: Fillmore, Houston, Winona		2	6	2			2							https://www.gundersenhealthplan.org/ForMembers/ProviderDirectory.aspx?membernetwork=SENIOR	N/A	N/A	(800)394-5566		(608)775-8077		(800)394-5566		(608)775-8077										(800)877-8973		(711)-		(800)877-8973		(711)-										2					2					2
H9847	001	0	1	04	01	H9847_001_0	7		1	08/02/2014	2015.01	08/02/2014 12:09:55 PM Eastern Daylight Time	08/04/2014 05:25:10 PM Eastern Daylight Time	08/01/2014 10:29:46 AM Eastern Daylight Time			08/05/2014 02:24:13 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.nc.chcadvantra.com	Advantra Gold (PPO)	01	04		1			H9847	001	0	2015	North Carolina Metro		2	10000	2			2							http://Providerdirectory.Coventry-Medicare.com	http://NCformulary.Coventry-Medicare.com	http://pharmacylocator.coventry-medicare.com	(866)731-9574		(866)731-9574		(855)893-4692		(855)893-4692		(877)300-5134		(877)300-5134		(855)893-4692		(855)893-4692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9847	005	0	1	04	01	H9847_005_0	9		1	08/02/2014	2015.01	08/02/2014 12:03:27 PM Eastern Daylight Time	08/04/2014 05:21:04 PM Eastern Daylight Time	08/01/2014 10:29:56 AM Eastern Daylight Time			08/05/2014 02:24:13 PM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	http://ga.chcadvantra.com	Advantra Preferred (PPO)	01	04		1			H9847	005	0	2015	Atlanta, Savannah, Augusta and Columbus areas		2	20000	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://pharmacylocator.coventry-medicare.com	(866)613-4977		(866)613-4977		(855)893-1443		(855)893-1443		(800)690-3412		(800)690-3412		(855)893-1443		(855)893-1443		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9847	801	0	1	04	01	H9847_801_0	1		1	05/31/2014	2015.01	05/31/2014 09:32:39 AM Eastern Daylight Time	05/31/2014 09:24:08 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.nc.chcadvantra.com	Coventry Advantra (PPO)	01	04		1			H9847	801	0	2015	North Carolina		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://NCformulary.Coventry-Medicare.com	http://Pharmacylocator.coventry-Medicare.com	(866)731-9574		(866)731-9574		(855)893-4692		(855)893-4692										(711)-		(711)-		(711)-		(711)-										1	1	011100001000000001111000001110000000	2		1					
H9847	802	0	1	04	01	H9847_802_0	1		1	05/13/2014	2015.01	05/13/2014 11:34:50 AM Eastern Daylight Time	05/31/2014 09:24:12 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.nc.chcadvantra.com	Coventry Advantra (PPO)	01	04		1			H9847	802	0	2015	North Carolina		1	50	2			2							http://Providerdirectory.Coventry-Medicare.com	http://NCformulary.Coventry-Medicare.com	http://Pharmacylocator.coventry-Medicare.com	(866)731-9574		(866)731-9574		(855)893-4692		(855)893-4692		(877)300-5134		(877)300-5134		(855)893-4692		(855)893-4692		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	000100001000000001111000001110000000	2		1					
H9847	804	0	1	04	01	H9847_804_0	1		1	05/13/2014	2015.01	05/13/2014 11:29:16 AM Eastern Daylight Time	05/31/2014 09:24:14 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.ga.chcadvantra.com	Advantra Preferred PPO (PPO)	01	04		1			H9847	804	0	2015	Atlanta, Savannah, Augusta and Columbus areas		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://Pharmacylocator.coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)893-1443		(855)893-1443										(711)-		(711)-		(711)-		(711)-										1	1	011100001000000000110000001100000100	2		1					
H9847	805	0	1	04	01	H9847_805_0	1		1	04/30/2014	2015.01	04/30/2014 11:34:40 AM Eastern Daylight Time	05/31/2014 09:24:06 AM Eastern Daylight Time				05/31/2014 09:35:36 AM Eastern Daylight Time	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Coventry Health Care	www.ga.chcadvantra.com	Advantra Preferred PPO (PPO)	01	04		1			H9847	805	0	2015	Atlanta, Savanah, Augusta and Columbus areas		1	100	2			2							http://Providerdirectory.Coventry-Medicare.com	http://GAformulary.Coventry-Medicare.com	http://Pharmacylocator.coventry-Medicare.com	(866)613-4977		(866)613-4977		(855)893-1443		(855)893-1443		(800)690-3412		(800)690-3412		(855)893-1443		(855)893-1443		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100001000000000110010001100000100	2		1					
H9857	001	0	1	01	01	H9857_001_0	5		1	08/05/2014	2015.01	08/05/2014 03:07:26 PM Eastern Daylight Time	08/05/2014 03:04:23 PM Eastern Daylight Time	08/05/2014 03:04:23 PM Eastern Daylight Time			08/05/2014 03:08:03 PM Eastern Daylight Time	PIEDMONT WELLSTAR HEALTHPLANS, INC.	Piedmont WellStar HealthPlans	pwplans.org/medicare	Piedmont WellStar Medicare Choice (HMO)	01	01		1			H9857	001	0	2015	Atlanta Metro		2	9650	2			2							pwplans.org	pwplans.org/medicare	pwplans.org/medicare	(855)222-1047		(855)222-1047		(855)222-1048		(855)222-1048		(855)222-1047		(855)222-1047		(855)222-1048		(855)222-1048		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		(855)275-1266		2					2					2
H9859	001	0	1	02	01	H9859_001_0	5		1	07/24/2014	2015.01	07/24/2014 09:12:06 PM Eastern Daylight Time	06/09/2014 07:35:56 AM Eastern Daylight Time				07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold without Part D (HMO-POS)	01	02		1			H9859	001	0	2015	Eastern NY, S. Tier NY, Mid-Hudson NY		2	352	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220										2					2					2
H9859	002	0	1	02	01	H9859_002_0	8		1	07/24/2014	2015.01	07/24/2014 09:11:29 PM Eastern Daylight Time	06/09/2014 07:35:44 AM Eastern Daylight Time	05/31/2014 03:31:10 PM Eastern Daylight Time			07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	Preferred Gold with Part D (HMO-POS)	01	02		1			H9859	002	0	2015	Eastern NY, S. Tier NY, Mid-Hudson NY		2	3400	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H9859	013	0	1	02	01	H9859_013_0	9		1	07/24/2014	2015.01	07/24/2014 09:11:38 PM Eastern Daylight Time	06/11/2014 05:54:43 PM Eastern Daylight Time	06/11/2014 05:54:43 PM Eastern Daylight Time			07/24/2014 09:15:53 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.joinMVPmedicare.com	GoldValue with Part D (HMO-POS)	01	02		1			H9859	013	0	2015	Central NY, Eastern NY, Mid-Hudson NY, Western VT		2	1921	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		2					2					2
H9859	802	0	1	02	01	H9859_802_0	4		1	05/29/2014	2015.01	05/29/2014 01:17:47 PM Eastern Daylight Time	06/11/2014 05:54:43 PM Eastern Daylight Time				06/12/2014 12:43:36 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP HEALTH CARE	www.mvphealthcare.com	Preferred Gold Rx - Employer Group (HMO-POS)	01	02		1			H9859	802	0	2015	Employer Group East Region		1	2911	2			2							www.mvphealthcare.com	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	www.mvphealthcare.com/medicare/2015PartD/partd_index.html	(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220		1	1	011111111111111111111111111111111111	2		1	1	011111111111111111111111111111111111	2		1
H9886	003	0	1	01	01	H9886_003_0	13	2	1	08/05/2014	2015.01	08/05/2014 05:29:17 PM Eastern Daylight Time	08/06/2014 04:07:42 PM Eastern Daylight Time	08/06/2014 04:08:47 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H9886	003	0	2015	Missouri		2	413	2			1	3		1	5			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8826		(855)251-8826		(800)797-6427		(800)797-6427		(855)251-8826		(855)251-8826		(800)797-6427		(800)797-6427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9886	004	0	1	01	01	H9886_004_0	15		1	08/05/2014	2015.01	08/05/2014 03:09:38 PM Eastern Daylight Time	08/06/2014 01:27:28 PM Eastern Daylight Time	08/06/2014 01:31:24 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H9886	004	0	2015	Missouri Select Counties		2	609	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8826		(855)251-8826		(800)797-6427		(800)797-6427		(855)251-8826		(855)251-8826		(800)797-6427		(800)797-6427		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9886	801	0	1	01	01	H9886_801_0	9		1	05/31/2014	2015.01	05/31/2014 11:41:57 AM Pacific Daylight Time	07/15/2014 01:25:36 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9886	801	0	2015	Select Counties in Missouri		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H9886	802	0	1	01	01	H9886_802_0	9		1	05/31/2014	2015.01	05/31/2014 11:42:07 AM Pacific Daylight Time	07/15/2014 01:25:41 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	HMO MISSOURI, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H9886	802	0	2015	Select Counties in Missouri		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)275-1404		(855)275-1404		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H9915	001	0	1	01	01	H9915_001_0	8		1	08/04/2014	2015.01	08/04/2014 03:19:01 PM Eastern Daylight Time	08/05/2014 12:54:54 PM Eastern Daylight Time	08/05/2014 12:54:30 PM Eastern Daylight Time			08/05/2014 05:00:00 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice (HMO)	01	01		1			H9915	001	0	2015	DC Metro		2	500	2			2							www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2
H9915	006	0	1	01	01	H9915_006_0	8	2	1	08/05/2014	2015.01	08/05/2014 04:56:46 PM Eastern Daylight Time	08/12/2014 10:31:25 AM Eastern Daylight Time	08/05/2014 12:55:06 PM Eastern Daylight Time			08/12/2014 10:33:11 AM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Dual Advantage (HMO SNP)	01	01		1			H9915	006	0	2015	DC Metro		2	500	2			1	3		1	3		2	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2
H9915	007	0	1	01	01	H9915_007_0	5		1	08/04/2014	2015.01	08/04/2014 03:19:13 PM Eastern Daylight Time	08/05/2014 12:56:06 PM Eastern Daylight Time	08/05/2014 12:55:42 PM Eastern Daylight Time			08/05/2014 05:00:00 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Care Advantage (HMO SNP)	01	01		1			H9915	007	0	2015	DC Metro		2	100	2			1	4		1		00000000000000000100		www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2
H9915	008	0	1	01	01	H9915_008_0	6		1	08/04/2014	2015.01	08/04/2014 03:19:29 PM Eastern Daylight Time	08/05/2014 12:56:42 PM Eastern Daylight Time	08/05/2014 12:56:18 PM Eastern Daylight Time			08/05/2014 05:00:00 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice (HMO)	01	01		1			H9915	008	0	2015	Baltimore Metro, Baltimore and DC Suburbs		2	1500	2			2							www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2
H9915	009	0	1	01	01	H9915_009_0	7	2	1	08/04/2014	2015.01	08/04/2014 03:20:19 PM Eastern Daylight Time	08/12/2014 10:31:26 AM Eastern Daylight Time	08/05/2014 12:56:54 PM Eastern Daylight Time			08/12/2014 10:33:11 AM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Dual Advantage (HMO SNP)	01	01		1			H9915	009	0	2015	Baltimore Metro, Baltimore and DC Suburbs		2	100	2			1	3		1	3		2	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2
H9915	010	0	1	01	01	H9915_010_0	6		1	08/04/2014	2015.01	08/04/2014 03:19:41 PM Eastern Daylight Time	08/05/2014 12:57:54 PM Eastern Daylight Time	08/05/2014 12:57:30 PM Eastern Daylight Time			08/05/2014 05:00:00 PM Eastern Daylight Time	MEDSTAR FAMILY CHOICE, INC.	MedStar Family Choice, Inc	www.medstarmedicarechoice.com	MedStar Medicare Choice Care Advantage (HMO SNP)	01	01		1			H9915	010	0	2015	Baltimore Metro, Baltimore and DC Suburbs		2	100	2			1	4		1		00000000000000000100		www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	www.medstarmedicarechoice.com	(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)222-1041		(855)222-1041		(855)242-4870		(855)242-4870		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		(855)250-5604		2					2					2
H9947	005	1	1	04	01	H9947_005_1	13		1	07/18/2014	2015.01	07/18/2014 12:45:55 PM Central Daylight Time	08/06/2014 02:54:08 AM Eastern Daylight Time	08/01/2014 05:31:27 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred Core (PPO)	01	04		1			H9947	005	1	2015	Georgia Metro Area	Segment 001	2	450	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9947	005	2	1	04	01	H9947_005_2	13		1	07/18/2014	2015.01	07/18/2014 12:46:11 PM Central Daylight Time	08/06/2014 02:54:13 AM Eastern Daylight Time	08/01/2014 05:31:28 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred Core (PPO)	01	04		1			H9947	005	2	2015	Georgia Metro Area	Segment 002	2	944	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(800)467-1199		(800)467-1199		(800)797-5957		(800)797-5957		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
H9947	801	0	1	04	01	H9947_801_0	8		1	05/30/2014	2015.01	05/30/2014 03:11:29 PM Pacific Daylight Time	07/15/2014 04:01:22 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		1			H9947	801	0	2015	Georgia		1	96577	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H9947	802	0	1	04	01	H9947_802_0	8		1	05/30/2014	2015.01	05/30/2014 03:11:36 PM Pacific Daylight Time	07/15/2014 04:01:34 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		1			H9947	802	0	2015	Georgia		1	905	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					
H9947	803	0	1	04	01	H9947_803_0	7		1	05/30/2014	2015.01	05/30/2014 03:11:42 PM Pacific Daylight Time	07/15/2014 04:01:49 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		1			H9947	803	0	2015	Georgia		1	50	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H9947	805	0	2	04	01	H9947_805_0	7		1	05/30/2014	2015.01	05/30/2014 03:11:47 PM Pacific Daylight Time	07/15/2014 04:01:57 PM Pacific Daylight Time				07/15/2014 04:04:17 PM Pacific Daylight Time	BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC.	Blue Cross Blue Shield of Georgia	www.bcbsga.com/medicare	Medicare Preferred (PPO)	01	04		2	1		H9947	805	0	2015	Georgia		1	785	2			2							www.bcbsga.com/medicare	www.bcbsga.com/medicare	www.bcbsga.com/medicare	(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(877)411-1640		(877)411-1640		(877)411-1647		(877)411-1647		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					
H9954	002	0	1	01	01	H9954_002_0	14		1	07/01/2014	2015.01	07/01/2014 10:24:55 AM Central Daylight Time	08/06/2014 01:27:48 PM Eastern Daylight Time	08/06/2014 01:30:59 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H9954	002	0	2015	Ft. Wayne		2	225	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(800)797-6421		(800)797-6421		(855)251-8827		(855)251-8827		(800)797-6421		(800)797-6421		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9954	004	0	1	01	01	H9954_004_0	12	2	1	08/05/2014	2015.01	08/05/2014 05:32:57 PM Eastern Daylight Time	08/06/2014 04:07:52 PM Eastern Daylight Time	08/06/2014 04:08:56 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem Dual Advantage (HMO SNP)	01	01		1			H9954	004	0	2015	Indiana		2	109	2			1	3		1	5			www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(800)797-6421		(800)797-6421		(855)251-8827		(855)251-8827		(800)797-6421		(800)797-6421		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9954	005	0	1	01	01	H9954_005_0	15		1	07/07/2014	2015.01	07/07/2014 11:01:30 AM Eastern Daylight Time	08/06/2014 01:28:01 PM Eastern Daylight Time	08/06/2014 01:31:08 PM Eastern Daylight Time			08/06/2014 05:06:14 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue Select (HMO)	01	01		1			H9954	005	0	2015	Indiana Select Counties		2	447	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(855)251-8827		(855)251-8827		(800)797-6421		(800)797-6421		(855)251-8827		(855)251-8827		(800)797-6421		(800)797-6421		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					2
H9954	801	0	1	01	01	H9954_801_0	8		1	05/31/2014	2015.01	05/31/2014 11:42:26 AM Pacific Daylight Time	07/15/2014 01:26:11 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Anthem MediBlue (HMO)	01	01		1			H9954	801	0	2015	Select Counties in Indiana		1	50	2			2							www.anthem.com/medicare	www.anthem.com/medicare	www.anthem.com/medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011100011110100111111111011110000100	2		1					1
H9954	802	0	1	01	01	H9954_802_0	8		1	05/31/2014	2015.01	05/31/2014 11:42:36 AM Pacific Daylight Time	07/15/2014 01:26:16 PM Pacific Daylight Time				07/15/2014 03:39:32 PM Pacific Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.Anthem.com/Medicare	Anthem MediBlue (HMO)	01	01		1			H9954	802	0	2015	Select Counties in Indiana		1	50	2			2							www.Anthem.com/Medicare	www.Anthem.com/Medicare	www.Anthem.com/Medicare	(855)275-1405		(855)275-1405		(866)845-8608		(866)845-8608										(711)-		(711)-		(711)-		(711)-										1	1	011100011110100111111111011110000100	2		1					1
H9998	001	0	1	20	08	H9998_001_0	1		1	05/28/2014	2015.01	05/28/2014 12:12:21 PM Central Daylight Time		05/22/2014 07:35:17 AM Central Daylight Time			05/28/2014 12:16:10 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstarlubbock.org	Silver Star - Dual (PACE)	08	20		1			H9998	001	0	2015	Silver Star - Dual		2		2			2								www.silverstarlubbock.org	http://www.seniorscript.com/									(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500												
H9998	002	0	1	20	08	H9998_002_0	1		1	05/28/2014	2015.01	05/28/2014 12:13:09 PM Central Daylight Time		05/22/2014 07:45:09 AM Central Daylight Time			05/28/2014 12:16:10 PM Central Daylight Time	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	Silver Star	www.silverstarlubbock.org	Silver Star - Medicare only (PACE)	08	20		1			H9998	002	0	2015	Silver Star - Medicare only		2		2			2								www.silverstarlubbock.org	http://www.seniorscript.com/									(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500										(806)767-1736		(806)740-1500		(806)767-1736		(806)740-1500												
R3175	003	0	1	31	11	R3175_003_0	3	2	1	08/04/2014	2015.02	08/04/2014 06:05:05 PM Central Daylight Time	08/04/2014 06:51:32 PM Central Daylight Time	07/31/2014 03:28:30 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R3175	003	0	2015	State of Hawaii		2		2			1	3		1	5			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(866)622-8054		(866)622-8054		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R3175	801	0	1	31	11	R3175_801_0	2		1	05/22/2014	2015.01	05/22/2014 09:41:25 AM Central Daylight Time	08/04/2014 06:51:48 PM Central Daylight Time				08/06/2014 10:09:38 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	801	0	2015	State of Hawaii		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
R3175	802	0	1	31	11	R3175_802_0	2		1	05/22/2014	2015.01	05/22/2014 09:26:42 AM Central Daylight Time	08/04/2014 06:52:05 PM Central Daylight Time				08/06/2014 10:09:38 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R3175	802	0	2015	State of Hawaii		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
R3332	001	0	1	31	11	R3332_001_0	11		1	08/05/2014	2015.01	08/05/2014 03:05:22 PM Eastern Daylight Time	08/05/2014 10:03:07 PM Eastern Daylight Time	07/31/2014 04:16:10 PM Eastern Daylight Time			08/06/2014 03:41:58 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Regional PPO (Regional PPO)	11	31		1			R3332	001	0	2015	State of Florida		2		2			2							www.BlueMedicareFL.com	MyPrime.com	www.myprime.com	(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770		2					2					
R3444	008	0	1	31	11	R3444_008_0	3		1	08/06/2014	2015.02	08/06/2014 10:41:32 AM Central Daylight Time	08/05/2014 09:51:52 AM Central Daylight Time	07/31/2014 03:28:34 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (Regional PPO SNP)	11	31		1			R3444	008	0	2015	Arkansas and Missouri		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R3444	009	0	1	31	11	R3444_009_0	5		1	08/06/2014	2015.02	08/06/2014 10:41:57 AM Central Daylight Time	08/05/2014 09:52:21 AM Central Daylight Time	07/31/2014 03:28:37 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (Regional PPO SNP)	11	31		1			R3444	009	0	2015	Arkansas and Missouri		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R3444	011	0	1	31	11	R3444_011_0	3	2	1	08/04/2014	2015.02	08/04/2014 05:38:54 PM Central Daylight Time	08/04/2014 06:53:08 PM Central Daylight Time	07/31/2014 03:28:41 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (Regional PPO SNP)	11	31		1			R3444	011	0	2015	Arkansas and Missouri		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R3444	012	0	1	31	11	R3444_012_0	4		1	08/05/2014	2015.02	08/05/2014 11:13:25 AM Central Daylight Time	08/05/2014 09:55:04 AM Central Daylight Time	07/31/2014 03:28:44 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (Regional PPO)	11	31		1			R3444	012	0	2015	Arkansas and Missouri		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5287	001	0	1	31	11	R5287_001_0	3		1	08/04/2014	2015.02	08/04/2014 05:08:10 PM Central Daylight Time	08/05/2014 09:46:42 AM Central Daylight Time	07/31/2014 03:28:47 PM Central Daylight Time			08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Plan 2 (Regional PPO)	11	31		1			R5287	001	0	2015	State of Florida		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5287	002	0	1	31	11	R5287_002_0	2		1	08/04/2014	2015.02	08/04/2014 05:14:02 PM Central Daylight Time	08/05/2014 09:50:35 AM Central Daylight Time				08/06/2014 09:38:22 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice Essential (Regional PPO)	11	31		1			R5287	002	0	2015	State of Florida		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514										(711)-		(711)-		(711)-		(711)-										2					2					
R5287	003	0	1	31	11	R5287_003_0	3	2	1	08/04/2014	2015.02	08/04/2014 06:30:15 PM Central Daylight Time	08/04/2014 06:24:13 PM Central Daylight Time	07/31/2014 03:28:50 PM Central Daylight Time			08/06/2014 09:58:27 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.UHCCommunityPlan.com	UnitedHealthcare Dual Complete RP (Regional PPO SNP)	11	31		1			R5287	003	0	2015	State of Florida		2		2			1	3		1	2			www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(877)702-5110		(877)702-5110		(888)834-3721		(888)834-3721		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5342	001	0	1	31	11	R5342_001_0	2		1	05/30/2014	2015.01	05/30/2014 04:45:16 PM Central Daylight Time	08/04/2014 06:24:49 PM Central Daylight Time	07/31/2014 03:29:27 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice (Regional PPO)	11	31		1			R5342	001	0	2015	State of New York		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5342	002	0	1	31	11	R5342_002_0	2		1	05/29/2014	2015.01	05/29/2014 01:03:47 PM Central Daylight Time	08/04/2014 06:25:06 PM Central Daylight Time				08/06/2014 10:06:33 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCMedicareSolutions.com	UnitedHealthcare MedicareComplete Choice Essential (Regional PPO)	11	31		1			R5342	002	0	2015	State of New York		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)711-6088		(800)711-6088		(800)555-5757		(800)555-5757										(711)-		(711)-		(711)-		(711)-										2					2					
R5342	801	0	1	31	11	R5342_801_0	2		1	05/22/2014	2015.01	05/22/2014 09:27:21 AM Central Daylight Time	08/04/2014 06:25:23 PM Central Daylight Time				08/06/2014 10:09:38 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	801	0	2015	State of New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
R5342	802	0	1	31	11	R5342_802_0	2		1	05/22/2014	2015.01	05/22/2014 09:27:25 AM Central Daylight Time	08/04/2014 06:25:39 PM Central Daylight Time				08/06/2014 10:09:38 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	802	0	2015	State of New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178										(711)-		(711)-		(711)-		(711)-										1	2		2		1					
R5342	803	0	1	31	11	R5342_803_0	2		1	05/22/2014	2015.01	05/22/2014 09:27:29 AM Central Daylight Time	08/04/2014 06:25:56 PM Central Daylight Time				08/06/2014 10:09:38 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.UHCretiree.com	UnitedHealthcare Group Medicare Advantage (Regional PPO)	11	31		1			R5342	803	0	2015	New York		1		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(800)457-8506		(800)457-8506		(877)714-0178		(877)714-0178		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	2		2		1					
R5826	001	0	1	31	11	R5826_001_0	3		1	08/02/2014	2015.02	08/02/2014 02:23:41 PM Eastern Daylight Time	08/02/2014 01:21:48 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:27:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-001 (Regional PPO)	11	31		1			R5826	001	0	2015	States of Alabama and Tennessee		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	002	0	1	31	11	R5826_002_0	3		1	07/10/2014	2015.02	07/10/2014 01:47:23 PM Eastern Daylight Time	08/03/2014 06:15:11 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 09:15:09 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-002 (Regional PPO)	11	31		1			R5826	002	0	2015	States of Pennsylvania and West Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	005	0	1	31	11	R5826_005_0	3		1	08/02/2014	2015.02	08/02/2014 04:30:48 PM Eastern Daylight Time	08/05/2014 07:46:47 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/05/2014 05:25:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-005 (Regional PPO)	11	31		1			R5826	005	0	2015	State of Florida		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	006	0	1	31	11	R5826_006_0	3		1	07/10/2014	2015.02	07/10/2014 01:57:27 PM Eastern Daylight Time	08/04/2014 09:17:16 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-006 (Regional PPO)	11	31		1			R5826	006	0	2015	State of Michigan		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	007	0	1	31	11	R5826_007_0	4		1	07/10/2014	2015.02	07/10/2014 01:38:01 PM Eastern Daylight Time	08/05/2014 09:55:27 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 11:43:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-007 (Regional PPO)	11	31		1			R5826	007	0	2015	State of Ohio		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	008	0	1	31	11	R5826_008_0	3		1	07/10/2014	2015.02	07/10/2014 03:03:51 PM Eastern Daylight Time	08/02/2014 08:09:50 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-008 (Regional PPO)	11	31		1			R5826	008	0	2015	States of Indiana and Kentucky		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	009	0	1	31	11	R5826_009_0	6		1	07/11/2014	2015.02	07/11/2014 10:12:56 AM Eastern Daylight Time	08/04/2014 09:15:15 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:53:07 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-009 (Regional PPO)	11	31		1			R5826	009	0	2015	States of Illinois and Wisconsin		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	010	0	1	31	11	R5826_010_0	3		1	08/02/2014	2015.02	08/02/2014 02:27:08 PM Eastern Daylight Time	08/04/2014 02:36:04 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 09:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-010 (Regional PPO)	11	31		1			R5826	010	0	2015	States of Arkansas and Missouri		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	011	0	1	31	11	R5826_011_0	5		1	08/14/2014	2015.02	08/14/2014 03:48:54 PM Eastern Daylight Time	08/02/2014 05:20:06 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/14/2014 04:02:13 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-011 (Regional PPO)	11	31		1			R5826	011	0	2015	States of Louisiana and Mississippi		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	012	0	1	31	11	R5826_012_0	3		1	07/10/2014	2015.02	07/10/2014 01:26:03 PM Eastern Daylight Time	08/05/2014 02:02:58 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-012 (Regional PPO)	11	31		1			R5826	012	0	2015	State of Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	013	0	1	31	11	R5826_013_0	3		1	07/10/2014	2015.02	07/10/2014 01:20:17 PM Eastern Daylight Time	08/04/2014 02:35:10 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 09:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-013 (Regional PPO)	11	31		1			R5826	013	0	2015	States of Kansas and Oklahoma		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	014	0	1	31	11	R5826_014_0	3		1	07/10/2014	2015.02	07/10/2014 11:25:30 AM Eastern Daylight Time	08/04/2014 05:03:20 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 07:33:16 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-014 (Regional PPO)	11	31		1			R5826	014	0	2015	State of Arizona		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	018	0	1	31	11	R5826_018_0	4		1	08/13/2014	2015.02	08/13/2014 10:40:38 AM Eastern Daylight Time	08/05/2014 07:39:39 AM Eastern Daylight Time				08/14/2014 02:30:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-018 (Regional PPO)	11	31		1			R5826	018	0	2015	State of Florida		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	021	0	1	31	11	R5826_021_0	3		1	08/02/2014	2015.02	08/02/2014 10:43:41 AM Eastern Daylight Time	08/05/2014 09:36:55 AM Eastern Daylight Time				08/06/2014 11:43:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-021 (Regional PPO)	11	31		1			R5826	021	0	2015	State of Ohio		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	023	0	1	31	11	R5826_023_0	3		1	07/10/2014	2015.02	07/10/2014 02:03:41 PM Eastern Daylight Time	08/04/2014 09:18:39 PM Eastern Daylight Time				08/06/2014 01:39:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-023 (Regional PPO)	11	31		1			R5826	023	0	2015	States of Illinois and Wisconsin		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	026	0	1	31	11	R5826_026_0	3		1	08/02/2014	2015.02	08/02/2014 03:10:18 PM Eastern Daylight Time	08/05/2014 02:05:10 PM Eastern Daylight Time				08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-026 (Regional PPO)	11	31		1			R5826	026	0	2015	State of Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	053	0	1	31	11	R5826_053_0	3		1	07/10/2014	2015.02	07/10/2014 02:15:22 PM Eastern Daylight Time	08/04/2014 09:24:35 PM Eastern Daylight Time				08/06/2014 01:39:26 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-053 (Regional PPO)	11	31		1			R5826	053	0	2015	State of Michigan		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	062	0	1	31	11	R5826_062_0	4		1	07/10/2014	2015.02	07/10/2014 01:48:21 PM Eastern Daylight Time	08/03/2014 06:03:45 PM Eastern Daylight Time				08/14/2014 02:23:30 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-062 (Regional PPO)	11	31		1			R5826	062	0	2015	States of Pennsylvania and West Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	063	0	1	31	11	R5826_063_0	5		1	08/06/2014	2015.01	08/06/2014 04:23:00 PM Eastern Daylight Time	08/05/2014 11:14:29 AM Eastern Daylight Time				08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-063 (Regional PPO)	11	31		1			R5826	063	0	2015	States of North Carolina and Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	064	0	1	31	11	R5826_064_0	4		1	08/06/2014	2015.01	08/06/2014 04:25:04 PM Eastern Daylight Time	08/05/2014 09:36:09 AM Eastern Daylight Time				08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-064 (Regional PPO)	11	31		1			R5826	064	0	2015	States of Georgia and South Carolina		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	065	0	1	31	11	R5826_065_0	3		1	07/10/2014	2015.02	07/10/2014 04:27:44 PM Eastern Daylight Time	08/02/2014 01:12:11 PM Eastern Daylight Time				08/06/2014 08:28:00 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-065 (Regional PPO)	11	31		1			R5826	065	0	2015	States of Alabama and Tennessee		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	066	0	1	31	11	R5826_066_0	4		1	08/02/2014	2015.02	08/02/2014 01:27:43 PM Eastern Daylight Time	08/02/2014 07:57:04 PM Eastern Daylight Time				08/06/2014 08:59:42 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-066 (Regional PPO)	11	31		1			R5826	066	0	2015	States of Indiana and Kentucky		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	067	0	1	31	11	R5826_067_0	3		1	08/02/2014	2015.02	08/02/2014 02:22:16 PM Eastern Daylight Time	08/04/2014 02:36:46 PM Eastern Daylight Time				08/06/2014 09:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-067 (Regional PPO)	11	31		1			R5826	067	0	2015	States of Arkansas and Missouri		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	068	0	1	31	11	R5826_068_0	3		1	07/10/2014	2015.02	07/10/2014 04:50:55 PM Eastern Daylight Time	08/02/2014 12:40:34 PM Eastern Daylight Time				08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-068 (Regional PPO)	11	31		1			R5826	068	0	2015	States of Louisiana and Mississippi		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	069	0	1	31	11	R5826_069_0	3		1	07/10/2014	2015.02	07/10/2014 01:22:24 PM Eastern Daylight Time	08/04/2014 02:37:26 PM Eastern Daylight Time				08/06/2014 09:15:13 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-069 (Regional PPO)	11	31		1			R5826	069	0	2015	States of Kansas and Oklahoma		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	070	0	1	31	11	R5826_070_0	3		1	07/10/2014	2015.02	07/10/2014 11:38:07 AM Eastern Daylight Time	08/04/2014 05:02:28 PM Eastern Daylight Time				08/06/2014 08:25:29 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-070 (Regional PPO)	11	31		1			R5826	070	0	2015	State of Arizona		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										2					2					
R5826	074	0	1	31	11	R5826_074_0	4		1	08/13/2014	2015.02	08/13/2014 10:43:32 AM Eastern Daylight Time	08/05/2014 07:40:52 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/14/2014 02:30:23 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-074 (Regional PPO)	11	31		1			R5826	074	0	2015	State of Florida		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	077	0	1	31	11	R5826_077_0	4		1	08/06/2014	2015.01	08/06/2014 06:58:50 PM Eastern Daylight Time	08/05/2014 09:37:39 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-077 (Regional PPO)	11	31		1			R5826	077	0	2015	States of Georgia and South Carolina		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	078	0	1	31	11	R5826_078_0	3		1	08/04/2014	2015.02	08/04/2014 02:27:41 PM Eastern Daylight Time	08/02/2014 05:26:37 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 07:29:19 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-078 (Regional PPO)	11	31		1			R5826	078	0	2015	States of Louisiana and Mississippi		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	079	0	1	31	11	R5826_079_0	5		1	08/06/2014	2015.01	08/06/2014 07:15:13 PM Eastern Daylight Time	08/05/2014 11:15:07 AM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:56:57 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-079 (Regional PPO)	11	31		1			R5826	079	0	2015	States of North Carolina and Virginia		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	091	0	1	31	11	R5826_091_0	3		1	08/02/2014	2015.02	08/02/2014 03:15:20 PM Eastern Daylight Time	08/05/2014 02:18:10 PM Eastern Daylight Time	08/04/2014 05:04:20 PM Eastern Daylight Time			08/06/2014 08:11:59 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	HumanaChoice R5826-091 (Regional PPO)	11	31		1			R5826	091	0	2015	State of Texas		2		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5826	801	0	1	31	11	R5826_801_0	3		1	05/27/2014	2015.02	05/27/2014 12:55:53 PM Eastern Daylight Time	08/04/2014 12:17:16 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	801	0	2015	States of Alabama and Tennessee		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	802	0	1	31	11	R5826_802_0	3		1	05/27/2014	2015.02	05/27/2014 01:18:42 PM Eastern Daylight Time	08/04/2014 12:17:35 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	802	0	2015	States of Pennsylvania and West Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	803	0	1	31	11	R5826_803_0	3		1	05/27/2014	2015.02	05/27/2014 01:18:49 PM Eastern Daylight Time	08/04/2014 12:17:56 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	803	0	2015	States of North Carolina and Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	804	0	1	31	11	R5826_804_0	3		1	05/27/2014	2015.02	05/27/2014 01:18:57 PM Eastern Daylight Time	08/04/2014 12:18:15 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	804	0	2015	States of Georgia and South Carolina		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	805	0	1	31	11	R5826_805_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:04 PM Eastern Daylight Time	08/04/2014 12:18:34 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	805	0	2015	State of Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	806	0	1	31	11	R5826_806_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:11 PM Eastern Daylight Time	08/04/2014 12:18:54 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	806	0	2015	State of Michigan		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	807	0	1	31	11	R5826_807_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:19 PM Eastern Daylight Time	08/04/2014 12:19:13 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	807	0	2015	State of Ohio		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	808	0	1	31	11	R5826_808_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:26 PM Eastern Daylight Time	08/04/2014 12:19:32 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	808	0	2015	States of Indiana and Kentucky		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	809	0	1	31	11	R5826_809_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:35 PM Eastern Daylight Time	08/04/2014 12:20:33 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	809	0	2015	States of Illinois and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	810	0	1	31	11	R5826_810_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:41 PM Eastern Daylight Time	08/04/2014 12:19:53 PM Eastern Daylight Time				08/06/2014 09:51:20 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	810	0	2015	States of Arkansas and Missouri		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	811	0	1	31	11	R5826_811_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:48 PM Eastern Daylight Time	08/04/2014 12:20:13 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	811	0	2015	States of Louisiana and Mississippi		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	812	0	1	31	11	R5826_812_0	3		1	05/27/2014	2015.02	05/27/2014 01:19:55 PM Eastern Daylight Time	08/04/2014 12:20:52 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	812	0	2015	State of Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	813	0	1	31	11	R5826_813_0	3		1	05/27/2014	2015.02	05/27/2014 01:20:02 PM Eastern Daylight Time	08/04/2014 12:24:04 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	813	0	2015	States of Kansas and Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	814	0	1	31	11	R5826_814_0	3		1	05/27/2014	2015.02	05/27/2014 01:20:08 PM Eastern Daylight Time	08/04/2014 12:24:24 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	814	0	2015	State of Arizona		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	815	0	1	31	11	R5826_815_0	3		1	05/27/2014	2015.02	05/27/2014 01:45:44 PM Eastern Daylight Time	08/04/2014 12:24:44 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	815	0	2015	States of Alabama and Tennessee		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	816	0	1	31	11	R5826_816_0	3		1	05/27/2014	2015.02	05/27/2014 01:44:45 PM Eastern Daylight Time	08/04/2014 12:25:24 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	816	0	2015	States of Pennsylvania and West Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	817	0	1	31	11	R5826_817_0	3		1	05/27/2014	2015.02	05/27/2014 01:44:26 PM Eastern Daylight Time	08/04/2014 12:26:05 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	817	0	2015	States of North Carolina and Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	818	0	1	31	11	R5826_818_0	3		1	05/27/2014	2015.02	05/27/2014 01:46:30 PM Eastern Daylight Time	08/04/2014 12:26:46 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	818	0	2015	States of Georgia and South Carolina		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	819	0	1	31	11	R5826_819_0	3		1	05/27/2014	2015.02	05/27/2014 01:46:42 PM Eastern Daylight Time	08/04/2014 12:27:26 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	819	0	2015	State of Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	820	0	1	31	11	R5826_820_0	3		1	05/27/2014	2015.02	05/27/2014 01:46:52 PM Eastern Daylight Time	08/04/2014 12:28:07 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	820	0	2015	State of Michigan		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	821	0	1	31	11	R5826_821_0	3		1	05/27/2014	2015.02	05/27/2014 01:47:09 PM Eastern Daylight Time	08/04/2014 12:28:46 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	821	0	2015	State of Ohio		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	822	0	1	31	11	R5826_822_0	3		1	05/27/2014	2015.02	05/27/2014 01:47:30 PM Eastern Daylight Time	08/04/2014 12:29:26 PM Eastern Daylight Time				08/06/2014 10:20:08 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	822	0	2015	States of Indiana and Kentucky		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	823	0	1	31	11	R5826_823_0	3		1	05/27/2014	2015.02	05/27/2014 01:47:42 PM Eastern Daylight Time	08/04/2014 12:30:06 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	823	0	2015	States of Illinois and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	824	0	1	31	11	R5826_824_0	3		1	05/27/2014	2015.02	05/27/2014 01:47:52 PM Eastern Daylight Time	08/04/2014 12:30:46 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	824	0	2015	States of Arkansas and Missouri		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	825	0	1	31	11	R5826_825_0	3		1	05/27/2014	2015.02	05/27/2014 01:48:47 PM Eastern Daylight Time	08/04/2014 12:31:26 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	825	0	2015	States of Louisiana and Mississippi		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	826	0	1	31	11	R5826_826_0	3		1	05/27/2014	2015.02	05/27/2014 01:48:58 PM Eastern Daylight Time	08/04/2014 12:32:08 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	826	0	2015	State of Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	827	0	1	31	11	R5826_827_0	3		1	05/27/2014	2015.02	05/27/2014 01:48:35 PM Eastern Daylight Time	08/04/2014 12:32:49 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	827	0	2015	States of Kansas and Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	828	0	1	31	11	R5826_828_0	3		1	05/27/2014	2015.02	05/27/2014 01:48:22 PM Eastern Daylight Time	08/04/2014 12:33:33 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (Regional PPO)	11	31		1			R5826	828	0	2015	State of Arizona		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364										(711)-		(711)-		(711)-		(711)-										1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	831	0	1	31	11	R5826_831_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:13 PM Eastern Daylight Time	08/04/2014 12:25:45 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	831	0	2015	States of Pennsylvania and West Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	832	0	1	31	11	R5826_832_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:21 PM Eastern Daylight Time	08/04/2014 12:26:26 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	832	0	2015	States of North Carolina and Virginia		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	833	0	1	31	11	R5826_833_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:29 PM Eastern Daylight Time	08/04/2014 12:27:06 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	833	0	2015	States of Georgia and South Carolina		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	834	0	1	31	11	R5826_834_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:36 PM Eastern Daylight Time	08/04/2014 12:27:46 PM Eastern Daylight Time				08/06/2014 10:30:46 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	834	0	2015	State of Florida		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	835	0	1	31	11	R5826_835_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:42 PM Eastern Daylight Time	08/04/2014 12:25:04 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	835	0	2015	States of Alabama and Tennessee		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	836	0	1	31	11	R5826_836_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:49 PM Eastern Daylight Time	08/04/2014 12:28:27 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	836	0	2015	State of Michigan		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	837	0	1	31	11	R5826_837_0	3		1	05/27/2014	2015.02	05/27/2014 01:22:56 PM Eastern Daylight Time	08/04/2014 12:29:07 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	837	0	2015	State of Ohio		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	838	0	1	31	11	R5826_838_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:03 PM Eastern Daylight Time	08/04/2014 12:29:46 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	838	0	2015	States of Indiana and Kentucky		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	839	0	1	31	11	R5826_839_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:10 PM Eastern Daylight Time	08/04/2014 12:30:26 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	839	0	2015	States of Illinois and Wisconsin		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	840	0	1	31	11	R5826_840_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:17 PM Eastern Daylight Time	08/04/2014 12:31:07 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	840	0	2015	States of Arkansas and Missouri		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	841	0	1	31	11	R5826_841_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:25 PM Eastern Daylight Time	08/04/2014 12:31:48 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	841	0	2015	States of Louisiana and Mississippi		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	842	0	1	31	11	R5826_842_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:32 PM Eastern Daylight Time	08/04/2014 12:32:29 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	842	0	2015	State of Texas		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	843	0	1	31	11	R5826_843_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:41 PM Eastern Daylight Time	08/04/2014 12:33:13 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	843	0	2015	States of Kansas and Oklahoma		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5826	844	0	1	31	11	R5826_844_0	3		1	05/27/2014	2015.02	05/27/2014 01:23:48 PM Eastern Daylight Time	08/04/2014 12:33:53 PM Eastern Daylight Time				08/06/2014 10:40:01 AM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (Regional PPO)	11	31		1			R5826	844	0	2015	State of Arizona		1		2			2							www.humana.com/members/tools	www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs	(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(800)457-4708		(800)457-4708		(800)833-2364		(800)833-2364		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		1	1	011111111111111111111111111111111111	1	111111111111111111111111111	1					
R5941	013	0	1	31	11	R5941_013_0	10		1	07/18/2014	2015.01	07/18/2014 12:46:27 PM Central Daylight Time	08/06/2014 02:54:26 AM Eastern Daylight Time				08/06/2014 04:26:39 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Blue Medicare Access Classic (Regional PPO)	11	31		1			R5941	013	0	2015	Ohio		2	2449	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560										(711)-		(711)-		(711)-		(711)-										2					2					
R5941	014	0	1	31	11	R5941_014_0	12		1	07/18/2014	2015.01	07/18/2014 12:46:41 PM Central Daylight Time	08/06/2014 02:54:30 AM Eastern Daylight Time	08/01/2014 05:31:30 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Blue Medicare Access Value (Regional PPO)	11	31		1			R5941	014	0	2015	Ohio		2	37909	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560		(800)467-1199		(800)467-1199		(800)797-0529		(800)797-0529		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R5941	015	0	1	31	11	R5941_015_0	12		1	07/18/2014	2015.01	07/18/2014 02:42:11 PM Central Daylight Time	08/06/2014 02:54:35 AM Eastern Daylight Time	08/01/2014 05:31:31 PM Eastern Daylight Time			08/06/2014 04:26:39 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Anthem Blue Cross and Blue Shield	www.anthem.com/medicare	Blue Medicare Access Value (Regional PPO)	11	31		1			R5941	015	0	2015	Indiana and Kentucky		2	55059	2			2							www.anthem.com	www.anthem.com/medicare	www.anthem.com/medicare	(800)467-1199		(800)467-1199		(800)797-0560		(800)797-0560		(800)467-1199		(800)467-1199		(800)797-0529		(800)797-0529		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R6801	008	0	1	31	11	R6801_008_0	3		1	08/06/2014	2015.02	08/06/2014 11:14:47 AM Central Daylight Time	08/05/2014 03:20:12 PM Central Daylight Time	08/01/2014 12:25:21 PM Central Daylight Time			08/06/2014 02:54:14 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (Regional PPO SNP)	11	31		1			R6801	008	0	2015	Texas		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R6801	009	0	1	31	11	R6801_009_0	4		1	08/06/2014	2015.02	08/06/2014 11:16:50 AM Central Daylight Time	08/05/2014 03:23:18 PM Central Daylight Time	07/31/2014 03:29:31 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (Regional PPO SNP)	11	31		1			R6801	009	0	2015	Texas		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R6801	011	0	1	31	11	R6801_011_0	3	2	1	08/06/2014	2015.02	08/06/2014 11:17:39 AM Central Daylight Time	08/04/2014 06:43:27 PM Central Daylight Time	07/31/2014 03:29:34 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (Regional PPO SNP)	11	31		1			R6801	011	0	2015	Texas		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R6801	012	0	1	31	11	R6801_012_0	5		1	08/06/2014	2015.02	08/06/2014 01:24:30 PM Central Daylight Time	08/08/2014 09:58:14 AM Central Daylight Time	07/31/2014 03:29:38 PM Central Daylight Time			08/08/2014 10:48:57 AM Central Daylight Time	CARE IMPROVEMENT PLUS OF TEXAS INSURANCE COMPANY	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (Regional PPO)	11	31		1			R6801	012	0	2015	Texas		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R7444	001	0	1	31	11	R7444_001_0	2		1	05/30/2014	2015.01	05/30/2014 04:45:33 PM Central Daylight Time	08/04/2014 06:27:28 PM Central Daylight Time	07/31/2014 03:29:41 PM Central Daylight Time			08/06/2014 10:02:03 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicarePlans.com	AARP MedicareComplete Choice (Regional PPO)	11	31		1			R7444	001	0	2015	New England		2		2			2							www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	www.UHCMedicareSolutions.com	(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(800)643-4845		(800)643-4845		(800)547-5514		(800)547-5514		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R9896	008	0	1	31	11	R9896_008_0	4		1	08/06/2014	2015.02	08/06/2014 11:19:04 AM Central Daylight Time	08/04/2014 06:49:34 PM Central Daylight Time	07/31/2014 03:29:45 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Silver Rx (Regional PPO SNP)	11	31		1			R9896	008	0	2015	Georgia and South Carolina		2		2			1	4		1		00000000000000000100		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R9896	009	0	1	31	11	R9896_009_0	5		1	08/04/2014	2015.02	08/04/2014 06:46:30 PM Central Daylight Time	08/05/2014 09:56:08 AM Central Daylight Time	07/31/2014 03:29:48 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Gold Rx (Regional PPO SNP)	11	31		1			R9896	009	0	2015	Georgia and South Carolina		2		2			1	4		1		00000000000000000010		www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R9896	012	0	1	31	11	R9896_012_0	5		1	08/05/2014	2015.02	08/05/2014 03:55:08 PM Central Daylight Time	08/05/2014 09:56:49 AM Central Daylight Time	07/31/2014 03:29:51 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Medicare Advantage (Regional PPO)	11	31		1			R9896	012	0	2015	Georgia and South Carolina		2		2			2							www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
R9896	021	0	1	31	11	R9896_021_0	4	2	1	08/05/2014	2015.02	08/05/2014 03:49:02 PM Central Daylight Time	08/05/2014 02:58:21 PM Central Daylight Time	07/31/2014 03:29:55 PM Central Daylight Time			08/06/2014 02:03:22 PM Central Daylight Time	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Care Improvement Plus	www.CareImprovementPlus.com	Care Improvement Plus Dual Advantage (Regional PPO SNP)	11	31		1			R9896	021	0	2015	Georgia and South Carolina		2		2			1	3		1	5			www.CareImprovementPlus.com	www.CareImprovementPlus.com	www.CareImprovementPlus.com	(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(800)204-1002		(800)204-1002		(800)711-1656		(800)711-1656		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		(711)-		2					2					
S0064	001	0		29	10	S0064_001_0	3		1	05/31/2014	2015.01	05/31/2014 07:40:50 PM Eastern Daylight Time		07/17/2014 09:07:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	001	0	2015	States of Maine and New Hampshire		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	002	0		29	10	S0064_002_0	2		1	06/02/2014	2015.01	06/02/2014 10:58:16 AM Eastern Daylight Time		07/17/2014 09:07:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	002	0	2015	States of CT, MA, RI, and VT		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	003	0		29	10	S0064_003_0	2		1	06/01/2014	2015.01	06/01/2014 11:32:33 AM Eastern Daylight Time		07/17/2014 09:06:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	003	0	2015	State of New York		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	004	0		29	10	S0064_004_0	2		1	06/01/2014	2015.01	06/01/2014 10:30:58 PM Eastern Daylight Time		07/17/2014 09:05:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	004	0	2015	State of New Jersey		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	005	0		29	10	S0064_005_0	2		1	05/31/2014	2015.01	05/31/2014 07:46:41 PM Eastern Daylight Time		07/17/2014 09:08:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	005	0	2015	District of Columbia, Delaware, and Maryland		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	006	0		29	10	S0064_006_0	2		1	05/31/2014	2015.01	05/31/2014 07:47:49 PM Eastern Daylight Time		07/17/2014 09:11:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	006	0	2015	States of Pennsylvania and West Virginia		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	007	0		29	10	S0064_007_0	2		1	05/31/2014	2015.01	05/31/2014 07:48:48 PM Eastern Daylight Time		07/17/2014 09:10:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	007	0	2015	State of Virginia		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	008	0		29	10	S0064_008_0	2		1	05/31/2014	2015.01	05/31/2014 07:49:38 PM Eastern Daylight Time		07/17/2014 09:09:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	008	0	2015	State of North Carolina		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	009	0		29	10	S0064_009_0	2		1	05/31/2014	2015.01	05/31/2014 07:50:25 PM Eastern Daylight Time		07/17/2014 09:15:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	009	0	2015	State of South Carolina		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	010	0		29	10	S0064_010_0	2		1	05/31/2014	2015.01	05/31/2014 07:51:25 PM Eastern Daylight Time		07/17/2014 09:15:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	010	0	2015	State of Georgia		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	011	0		29	10	S0064_011_0	2		1	05/31/2014	2015.01	05/31/2014 07:52:15 PM Eastern Daylight Time		07/17/2014 09:14:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	011	0	2015	State of Florida		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	012	0		29	10	S0064_012_0	2		1	05/31/2014	2015.01	05/31/2014 07:53:29 PM Eastern Daylight Time		07/17/2014 09:13:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	012	0	2015	States of Alabama and Tennessee		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	013	0		29	10	S0064_013_0	2		1	05/31/2014	2015.01	05/31/2014 07:54:28 PM Eastern Daylight Time		07/17/2014 09:13:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	013	0	2015	State of Michigan		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	014	0		29	10	S0064_014_0	2		1	05/31/2014	2015.01	05/31/2014 07:55:35 PM Eastern Daylight Time		07/17/2014 09:12:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	014	0	2015	State of Ohio		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	015	0		29	10	S0064_015_0	2		1	05/31/2014	2015.01	05/31/2014 07:56:39 PM Eastern Daylight Time		07/17/2014 09:11:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	015	0	2015	States of Indiana and Kentucky		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	016	0		29	10	S0064_016_0	2		1	05/31/2014	2015.01	05/31/2014 07:57:33 PM Eastern Daylight Time		07/17/2014 09:18:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	016	0	2015	State of Wisconsin		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	017	0		29	10	S0064_017_0	2		1	05/31/2014	2015.01	05/31/2014 07:58:44 PM Eastern Daylight Time		07/17/2014 09:18:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	017	0	2015	State of Illinois		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	018	0		29	10	S0064_018_0	2		1	05/31/2014	2015.01	05/31/2014 07:59:29 PM Eastern Daylight Time		07/17/2014 09:17:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	018	0	2015	State of Missouri		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	019	0		29	10	S0064_019_0	2		1	05/31/2014	2015.01	05/31/2014 08:00:29 PM Eastern Daylight Time		07/17/2014 09:17:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	019	0	2015	State of Arkansas		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	020	0		29	10	S0064_020_0	2		1	05/31/2014	2015.01	05/31/2014 08:01:27 PM Eastern Daylight Time		07/17/2014 09:22:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	020	0	2015	State of Mississippi		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	021	0		29	10	S0064_021_0	2		1	05/31/2014	2015.01	05/31/2014 08:02:40 PM Eastern Daylight Time		07/17/2014 09:22:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	021	0	2015	State of Louisiana		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	022	0		29	10	S0064_022_0	2		1	05/31/2014	2015.01	05/31/2014 08:03:31 PM Eastern Daylight Time		07/17/2014 09:21:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	022	0	2015	State of Texas		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	023	0		29	10	S0064_023_0	2		1	05/31/2014	2015.01	05/31/2014 08:04:24 PM Eastern Daylight Time		07/17/2014 09:20:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	023	0	2015	State of Oklahoma		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	024	0		29	10	S0064_024_0	2		1	05/31/2014	2015.01	05/31/2014 08:05:17 PM Eastern Daylight Time		07/17/2014 09:20:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	024	0	2015	State of Kansas		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	025	0		29	10	S0064_025_0	2		1	05/31/2014	2015.01	05/31/2014 08:06:12 PM Eastern Daylight Time		07/17/2014 09:19:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	025	0	2015	States of  IA, MN, MT, ND, NE, SD, WY		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	026	0		29	10	S0064_026_0	2		1	05/31/2014	2015.01	05/31/2014 08:06:58 PM Eastern Daylight Time		07/17/2014 09:25:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	026	0	2015	State of New Mexico		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	027	0		29	10	S0064_027_0	2		1	05/31/2014	2015.01	05/31/2014 08:07:44 PM Eastern Daylight Time		07/17/2014 09:25:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	027	0	2015	State of Colorado		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	028	0		29	10	S0064_028_0	2		1	05/31/2014	2015.01	05/31/2014 08:08:32 PM Eastern Daylight Time		07/17/2014 09:24:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	028	0	2015	State of Arizona		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	029	0		29	10	S0064_029_0	2		1	05/31/2014	2015.01	05/31/2014 08:09:22 PM Eastern Daylight Time		07/17/2014 09:24:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	029	0	2015	State of Nevada		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	030	0		29	10	S0064_030_0	2		1	05/31/2014	2015.01	05/31/2014 08:10:07 PM Eastern Daylight Time		07/17/2014 09:23:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	030	0	2015	States of Oregon and Washington		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	031	0		29	10	S0064_031_0	2		1	05/31/2014	2015.01	05/31/2014 08:10:55 PM Eastern Daylight Time		07/17/2014 09:29:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	031	0	2015	States of Idaho and Utah		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	032	0		29	10	S0064_032_0	2		1	05/31/2014	2015.01	05/31/2014 08:11:51 PM Eastern Daylight Time		07/17/2014 09:28:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	032	0	2015	State of California		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	033	0		29	10	S0064_033_0	2		1	05/31/2014	2015.01	05/31/2014 08:12:40 PM Eastern Daylight Time		07/17/2014 09:28:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	033	0	2015	State of Hawaii		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	034	0		29	10	S0064_034_0	2		1	05/31/2014	2015.01	05/31/2014 08:13:41 PM Eastern Daylight Time		07/17/2014 09:27:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	034	0	2015	State of Alaska		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0064	035	0		29	10	S0064_035_0	2		1	05/31/2014	2015.01	05/31/2014 08:14:29 PM Eastern Daylight Time		07/17/2014 09:26:00 AM Eastern Daylight Time			07/17/2014 03:52:51 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT OF NY	Express Scripts Medicare	www.smartdrx.com	SmartD Rx Saver (PDP)	10	29					S0064	035	0	2015	Territory of Puerto Rico		2					2								www.smartdrx.com	www.smartdrx.com									(888)328-0420		(888)328-0420		(888)328-0420		(888)328-0420										(888)328-0419		(888)328-0419		(888)328-0419		(888)328-0419												
S0522	001	0		29	10	S0522_001_0	1		1	06/02/2014	2015.01	06/02/2014 09:07:56 AM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	001	0	2015	IL		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	002	0		29	10	S0522_002_0	1		1	05/30/2014	2015.01	05/30/2014 03:26:15 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	002	0	2015	NH ME		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	004	0		29	10	S0522_004_0	1		1	05/30/2014	2015.01	05/30/2014 03:26:34 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	004	0	2015	NJ		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	006	0		29	10	S0522_006_0	1		1	05/30/2014	2015.01	05/30/2014 03:27:08 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	006	0	2015	DE DC MD		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	008	0		29	10	S0522_008_0	1		1	05/30/2014	2015.01	05/30/2014 03:27:22 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	008	0	2015	VA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	010	0		29	10	S0522_010_0	1		1	05/30/2014	2015.01	05/30/2014 03:27:42 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	010	0	2015	NC		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	012	0		29	10	S0522_012_0	1		1	05/30/2014	2015.01	05/30/2014 03:27:55 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	012	0	2015	SC		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	014	0		29	10	S0522_014_0	1		1	05/30/2014	2015.01	05/30/2014 03:28:08 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	014	0	2015	GA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	016	0		29	10	S0522_016_0	1		1	05/30/2014	2015.01	05/30/2014 03:28:21 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	016	0	2015	AL TN		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	018	0		29	10	S0522_018_0	1		1	05/30/2014	2015.01	05/30/2014 03:28:37 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	018	0	2015	MI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	020	0		29	10	S0522_020_0	1		1	05/30/2014	2015.01	05/30/2014 03:28:51 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	020	0	2015	OH		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	022	0		29	10	S0522_022_0	1		1	05/30/2014	2015.01	05/30/2014 03:29:04 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	022	0	2015	IN KY		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	024	0		29	10	S0522_024_0	1		1	05/30/2014	2015.01	05/30/2014 03:29:18 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	024	0	2015	MS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	026	0		29	10	S0522_026_0	1		1	05/30/2014	2015.01	05/30/2014 03:29:33 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	026	0	2015	LA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	028	0		29	10	S0522_028_0	1		1	05/30/2014	2015.01	05/30/2014 03:29:45 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	028	0	2015	CO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	030	0		29	10	S0522_030_0	1		1	05/30/2014	2015.01	05/30/2014 03:29:58 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	030	0	2015	OR WA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	032	0		29	10	S0522_032_0	1		1	05/30/2014	2015.01	05/30/2014 03:30:15 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	032	0	2015	ID UT		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	034	0		29	10	S0522_034_0	1		1	05/30/2014	2015.01	05/30/2014 03:30:28 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	034	0	2015	CA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	036	0		29	10	S0522_036_0	1		1	05/30/2014	2015.01	05/30/2014 03:30:39 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	036	0	2015	WI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	037	0		29	10	S0522_037_0	1		1	05/30/2014	2015.01	05/30/2014 03:30:52 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	037	0	2015	MO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	038	0		29	10	S0522_038_0	1		1	05/30/2014	2015.01	05/30/2014 03:31:05 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	038	0	2015	AR		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	039	0		29	10	S0522_039_0	1		1	05/30/2014	2015.01	05/30/2014 03:53:23 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	039	0	2015	TX		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	040	0		29	10	S0522_040_0	1		1	05/30/2014	2015.01	05/30/2014 03:31:33 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	040	0	2015	OK		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	041	0		29	10	S0522_041_0	1		1	05/30/2014	2015.01	05/30/2014 03:31:46 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	041	0	2015	KS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	042	0		29	10	S0522_042_0	1		1	05/30/2014	2015.01	05/30/2014 03:32:00 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	042	0	2015	IA MN MT NE ND SD WY		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	043	0		29	10	S0522_043_0	1		1	05/30/2014	2015.01	05/30/2014 03:32:16 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	043	0	2015	NM		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	044	0		29	10	S0522_044_0	1		1	05/30/2014	2015.01	05/30/2014 03:32:29 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	044	0	2015	AZ		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	045	0		29	10	S0522_045_0	1		1	05/30/2014	2015.01	05/30/2014 03:32:44 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Value Rx (PDP)	10	29					S0522	045	0	2015	NV		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	046	0		29	10	S0522_046_0	1		1	05/30/2014	2015.01	05/30/2014 03:33:00 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	046	0	2015	HI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	047	0		29	10	S0522_047_0	1		1	05/30/2014	2015.01	05/30/2014 03:33:19 PM Central Daylight Time		06/02/2014 10:00:04 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Value Rx (PDP)	10	29					S0522	047	0	2015	AK		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	048	0		29	10	S0522_048_0	1		1	05/30/2014	2015.01	05/30/2014 03:33:33 PM Central Daylight Time		06/02/2014 10:01:40 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	048	0	2015	IL		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	049	0		29	10	S0522_049_0	1		1	05/30/2014	2015.01	05/30/2014 03:33:47 PM Central Daylight Time		06/02/2014 10:01:40 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	049	0	2015	Northern New England		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	050	0		29	10	S0522_050_0	1		1	05/30/2014	2015.01	05/30/2014 03:33:59 PM Central Daylight Time		06/02/2014 10:01:40 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	050	0	2015	New Jersey		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	051	0		29	10	S0522_051_0	1		1	05/30/2014	2015.01	05/30/2014 03:34:12 PM Central Daylight Time		06/02/2014 10:01:40 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	051	0	2015	Mid-Atlantic		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	052	0		29	10	S0522_052_0	1		1	05/30/2014	2015.01	05/30/2014 03:34:22 PM Central Daylight Time		06/02/2014 10:01:40 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	052	0	2015	Virginia		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	053	0		29	10	S0522_053_0	1		1	05/30/2014	2015.01	05/30/2014 03:34:36 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	053	0	2015	North Carolina		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	054	0		29	10	S0522_054_0	1		1	05/30/2014	2015.01	05/30/2014 03:34:51 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	054	0	2015	South Carolina		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	055	0		29	10	S0522_055_0	1		1	05/30/2014	2015.01	05/30/2014 03:35:04 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	055	0	2015	Georgia		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	056	0		29	10	S0522_056_0	1		1	05/30/2014	2015.01	05/30/2014 03:35:19 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	056	0	2015	AL TN		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	057	0		29	10	S0522_057_0	1		1	05/30/2014	2015.01	05/30/2014 03:35:30 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphoix Rite Aid Premier Rx (PDP)	10	29					S0522	057	0	2015	MI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	058	0		29	10	S0522_058_0	1		1	05/30/2014	2015.01	05/30/2014 03:35:42 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	058	0	2015	OH		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	059	0		29	10	S0522_059_0	1		1	05/30/2014	2015.01	05/30/2014 03:35:53 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	059	0	2015	IN KY		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	060	0		29	10	S0522_060_0	1		1	05/30/2014	2015.01	05/30/2014 03:36:07 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	060	0	2015	MS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	061	0		29	10	S0522_061_0	1		1	05/30/2014	2015.01	05/30/2014 03:36:19 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	061	0	2015	LA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	062	0		29	10	S0522_062_0	1		1	05/30/2014	2015.01	05/30/2014 03:36:33 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	062	0	2015	CO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	063	0		29	10	S0522_063_0	1		1	05/30/2014	2015.01	05/30/2014 03:36:44 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	063	0	2015	OR WA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	064	0		29	10	S0522_064_0	1		1	05/30/2014	2015.01	05/30/2014 03:36:54 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	064	0	2015	ID UT		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	065	0		29	10	S0522_065_0	1		1	05/30/2014	2015.01	05/30/2014 03:37:07 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	065	0	2015	CA		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	066	0		29	10	S0522_066_0	1		1	05/30/2014	2015.01	05/30/2014 03:37:18 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	066	0	2015	WI		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	067	0		29	10	S0522_067_0	1		1	05/30/2014	2015.01	05/30/2014 03:37:31 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	067	0	2015	MO		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	068	0		29	10	S0522_068_0	1		1	05/30/2014	2015.01	05/30/2014 03:37:43 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	068	0	2015	Arkansas		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	069	0		29	10	S0522_069_0	1		1	05/30/2014	2015.01	05/30/2014 03:37:55 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	069	0	2015	Texas		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	070	0		29	10	S0522_070_0	1		1	05/30/2014	2015.01	05/30/2014 03:38:07 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	070	0	2015	Oklahoma		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	071	0		29	10	S0522_071_0	1		1	05/30/2014	2015.01	05/30/2014 03:38:18 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	071	0	2015	KS		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	072	0		29	10	S0522_072_0	1		1	05/30/2014	2015.01	05/30/2014 03:38:29 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	072	0	2015	Upper Midwest and Northern Plains		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	073	0		29	10	S0522_073_0	1		1	05/30/2014	2015.01	05/30/2014 03:38:42 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	073	0	2015	NM		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	074	0		29	10	S0522_074_0	1		1	05/30/2014	2015.01	05/30/2014 03:38:54 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	074	0	2015	AZ		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	075	0		29	10	S0522_075_0	1		1	05/30/2014	2015.01	05/30/2014 03:39:05 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Rite Aid Premier Rx (PDP)	10	29					S0522	075	0	2015	NV		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	076	0		29	10	S0522_076_0	1		1	05/30/2014	2015.01	05/30/2014 03:39:16 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	076	0	2015	Hawaii		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0522	077	0		29	10	S0522_077_0	1		1	05/30/2014	2015.01	05/30/2014 03:39:30 PM Central Daylight Time		06/02/2014 10:01:41 AM Central Daylight Time			06/02/2014 10:17:03 AM Central Daylight Time	SYMPHONIX HEALTH INSURANCE, INC.	Symphonix Health	www.symphonixhealth.com	Symphonix Premier Rx (PDP)	10	29					S0522	077	0	2015	Alaska		2					2								www.symphonixhealth.com	www.symphonixhealth.com									(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280										(855)355-2280		(855)355-2280		(855)355-2280		(855)355-2280												
S0586	801	0		29	10	S0586_801_0	1		1	05/20/2014	2015.01	05/20/2014 01:10:33 PM Eastern Daylight Time					06/01/2014 02:40:29 PM Eastern Daylight Time	MVP HEALTH PLAN, INC.	MVP Health Care	www.mvphealthcare.com	MVP RxCare - Employer Group (PDP)	10	29					S0586	801	0	2015	United States and Puerto Rico		1					2								http://www.mvphealthcare.com/medicare/documents/Formulary.pdf	http://www.mvphealthcare.com/medicare/2013PartD/partd_index.html									(800)665-7924		(800)665-7924		(888)280-6205		(888)280-6205										(800)662-1220		(800)662-1220		(800)662-1220		(800)662-1220												
S0655	801	0		29	10	S0655_801_0	1		1	04/15/2014	2015.01	04/15/2014 10:42:50 AM Eastern Daylight Time					05/30/2014 05:18:02 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	801	0	2015	Massachusetts and Nationwide		1					2								tuftsmedicarepreferred.org/druglist.php	tuftsmedicarepreferred.org/druglist.php									(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977												
S0655	802	0		29	10	S0655_802_0	1		1	04/15/2014	2015.01	04/15/2014 10:42:54 AM Eastern Daylight Time					05/30/2014 05:18:02 PM Eastern Daylight Time	TUFTS INSURANCE COMPANY	Tufts Health Plan Medicare Preferred	tuftsmedicarepreferred.org	Tufts Medicare Preferred PDP Group (PDP)	10	29					S0655	802	0	2015	Massachusetts and Nationwide		1					2								tuftsmedicarepreferred.org/druglist.php	tuftsmedicarepreferred.org/druglist.php									(800)701-9000		(800)701-9000		(877)218-4835		(877)218-4835										(800)208-9562		(800)208-9562		(888)899-8977		(888)899-8977												
S0764	801	0		29	10	S0764_801_0	2		1	05/21/2014	2015.01	05/21/2014 02:32:37 PM Central Daylight Time					06/01/2014 11:54:50 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare	https://magellanpharmacysolutions.com/	Magellan Rx Advantage Plan (PDP)	10	29					S0764	801	0	2015	National		1					2							https://magellanpharmacysolutions.com/	https://magellanpharmacysolutions.com/	https://magellanpharmacysolutions.com/									(800)424-8009		(800)424-8009		(800)424-8009		(800)424-8009										(800)424-8009		(800)424-8009		(800)424-8009		(800)424-8009												
S0764	802	0		29	10	S0764_802_0	2		1	06/01/2014	2015.01	06/01/2014 11:35:23 AM Central Daylight Time					06/01/2014 11:54:50 AM Central Daylight Time	MAGELLAN LIFE INSURANCE COMPANY, INC.	Magellan Rx Medicare	https://magellanpharmacysolutions.com/	Magellan Rx Plus Plan (PDP)	10	29					S0764	802	0	2015	National		1					2							https://magellanpharmacysolutions.com/	https://magellanpharmacysolutions.com/	https://magellanpharmacysolutions.com/									(800)424-8009		(800)424-8009		(800)424-8009		(800)424-8009										(800)424-8009		(800)424-8009		(800)424-8009		(800)424-8009												
S0962	001	0		29	10	S0962_001_0	5		1	07/17/2014	2015.01	07/17/2014 10:55:38 AM Mountain Daylight Time		06/01/2014 05:00:45 PM Mountain Daylight Time			07/17/2014 12:28:04 PM Mountain Daylight Time	COLORADO ACCESS	Colorado Access Advantage Part D Plan	www.coaccess.com	Colorado Access Vista Medicare PDP (PDP)	10	29					S0962	001	0	2015	State of Colorado		2					2								http://www.aa.coaccess.com	http://www.aa.coaccess.com									(877)441-6032		(303)751-2657		(877)441-6032		(303)751-2657										(888)803-4494		(888)803-4494		(888)803-4494		(888)803-4494												
S1030	001	0		29	10	S1030_001_0	1		1	05/29/2014	2015.01	05/29/2014 09:58:15 AM Central Daylight Time		05/31/2014 02:49:06 PM Central Daylight Time			05/31/2014 03:12:26 PM Central Daylight Time	BCBS ALABAMA, BCBS TENNESSEE	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Option II (PDP)	10	29					S1030	001	0	2015	State of Alabama, State of Tennessee		2					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-												
S1030	006	0		29	10	S1030_006_0	2		1	06/30/2014	2015.01	06/30/2014 09:59:22 AM Central Daylight Time		07/02/2014 03:02:15 PM Central Daylight Time			07/02/2014 03:09:13 PM Central Daylight Time	BCBS ALABAMA, BCBS TENNESSEE	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Option I (PDP)	10	29					S1030	006	0	2015	State of Alabama, State of Tennessee		2					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-												
S1030	801	0		29	10	S1030_801_0	1		1	05/27/2014	2015.01	05/27/2014 01:29:44 PM Central Daylight Time					05/31/2014 02:52:29 PM Central Daylight Time	BCBS ALABAMA, BCBS TENNESSEE	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 801 (PDP)	10	29					S1030	801	0	2015	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)824-0435		(800)824-0435		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-												
S1030	802	0		29	10	S1030_802_0	1		1	05/27/2014	2015.01	05/27/2014 01:33:17 PM Central Daylight Time					05/31/2014 03:12:26 PM Central Daylight Time	BCBS ALABAMA, BCBS TENNESSEE	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 802 (PDP)	10	29					S1030	802	0	2015	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-												
S1030	803	0		29	10	S1030_803_0	1		1	04/28/2014	2015.01	04/28/2014 02:44:12 PM Central Daylight Time					05/31/2014 02:52:29 PM Central Daylight Time	BCBS ALABAMA, BCBS TENNESSEE	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 803 (PDP)	10	29					S1030	803	0	2015	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-												
S1030	804	0		29	10	S1030_804_0	1		1	05/27/2014	2015.01	05/27/2014 01:32:08 PM Central Daylight Time					05/31/2014 03:12:26 PM Central Daylight Time	BCBS ALABAMA, BCBS TENNESSEE	BlueRx (PDP)	www.bluerxalatenn.com	BlueRx Employer Group Plan 804 (PDP)	10	29					S1030	804	0	2015	State of Alabama, State of Tennessee		1					2								www.bluerxalatenn.com	www.bluerxalatenn.com									(800)327-3998		(800)327-3998		(877)233-3555		(877)233-3555										(711)-		(711)-		(711)-		(711)-												
S1140	001	0		29	10	S1140_001_0	1		1	05/29/2014	2015.02	05/29/2014 11:24:04 AM Eastern Daylight Time		06/01/2014 12:54:42 AM Eastern Daylight Time			06/01/2014 02:05:19 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	HealthNow New York Inc.	www.healthnowny.com/medicare	SmartSaver Rx PDP Value (PDP)	10	29					S1140	001	0	2015	New York State		2					2								www.healthnowny.com/medicare	www.healthnowny.com/medicareoptions									(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-												
S1140	002	0		29	10	S1140_002_0	1		1	05/29/2014	2015.02	05/29/2014 11:24:09 AM Eastern Daylight Time		06/01/2014 12:54:58 AM Eastern Daylight Time			06/01/2014 02:05:19 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	HealthNow New York Inc.	www.healthnowny.com/medicare	SmartSaver Rx PDP (PDP)	10	29					S1140	002	0	2015	New York State		2					2								www.healthnowny.com/medicare	www.healthnowny.com/medicareoptions									(888)787-2390		(888)787-2390		(888)989-9905		(888)989-9905										(711)-		(711)-		(711)-		(711)-												
S1140	801	0		29	10	S1140_801_0	1		1	05/17/2014	2015.02	05/17/2014 11:18:30 AM Eastern Daylight Time					06/01/2014 02:05:19 PM Eastern Daylight Time	HEALTHNOW NEW YORK INC.	HealthNow New York Inc.	www.healthnowny.com/medicareoptions	SmartSaver Rx EGWP PDP (PDP)	10	29					S1140	801	0	2015	New York State		1					2								www.healthnowny.com/medicare	www.healthnowny.com/medicare									(888)787-2390		(888)787-2390		(855)215-9232		(855)215-9232										(711)-		(711)-		(877)286-5710		(877)286-5710												
S1822	801	0		29	10	S1822_801_0	1		1	05/09/2014	2015.01	05/09/2014 03:37:12 PM Central Daylight Time					05/09/2014 03:48:35 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners National PDP	healthpartners.com/medicare	HealthPartners Retiree National Choice CY (PDP)	10	29					S1822	801	0	2015	Nationwide		1					2								healthpartners.com/medicarerx	healthpartners.com/medicare									(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060												
S1822	802	0		29	10	S1822_802_0	1		1	05/09/2014	2015.01	05/09/2014 03:48:28 PM Central Daylight Time					05/09/2014 03:51:38 PM Central Daylight Time	HEALTHPARTNERS, INC.	HealthPartners National PDP	healthpartners.com/medicare	HealthPartners Retiree National Choice NCY (PDP)	10	29					S1822	802	0	2015	Nationwide		1					2								healthpartners.com/medicarerx	healthpartners.com/medicare									(877)816-9539		(952)883-7373		(866)993-7428		(952)883-7428										(800)443-0156		(952)883-6060		(800)443-0156		(952)883-6060												
S2468	003	0		29	10	S2468_003_0	2		1	05/28/2014	2015.01	05/28/2014 04:13:01 PM Pacific Daylight Time		07/07/2014 02:31:33 PM Pacific Daylight Time			07/09/2014 01:48:04 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare Basic Plan (PDP)	10	29					S2468	003	0	2015	State of California		2					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-												
S2468	004	0		29	10	S2468_004_0	3		1	05/27/2014	2015.01	05/27/2014 05:20:44 PM Pacific Daylight Time		07/07/2014 02:33:40 PM Pacific Daylight Time			07/09/2014 01:52:09 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com/findamedicareplan	Blue Shield Medicare Enhanced Plan (PDP)	10	29					S2468	004	0	2015	State of California		2					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(800)488-8000		(800)488-8000										(711)-		(711)-		(711)-		(711)-												
S2468	801	0		29	10	S2468_801_0	2		1	05/22/2014	2015.01	05/22/2014 01:05:06 PM Pacific Daylight Time					06/02/2014 02:15:38 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	801	0	2015	PDP Employer Group Plan		1					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-												
S2468	802	0		29	10	S2468_802_0	2		1	05/22/2014	2015.01	05/22/2014 01:05:28 PM Pacific Daylight Time					06/02/2014 02:17:23 PM Pacific Daylight Time	CALIFORNIA PHYSICIANS' SERVICE	Blue Shield of California	www.blueshieldca.com	Blue Shield of California Medicare Rx Plan (PDP)	10	29					S2468	802	0	2015	PDP Employer Group Plan		1					2								www.blueshieldca.com/med_formulary	www.blueshieldca.com/med_pharmacy									(888)239-6469		(888)239-6469		(888)239-6469		(888)239-6469										(711)-		(711)-		(711)-		(711)-												
S2505	001	0		29	10	S2505_001_0	4		1	05/29/2014	2015.02	05/29/2014 02:53:00 PM Eastern Daylight Time		06/02/2014 01:58:56 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	001	0	2015	Alabama and Tennessee		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S2505	003	0		29	10	S2505_003_0	4		1	05/29/2014	2015.02	05/29/2014 02:54:02 PM Eastern Daylight Time		06/02/2014 01:59:07 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	003	0	2015	Arkansas		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S2505	005	0		29	10	S2505_005_0	4		1	05/30/2014	2015.02	05/30/2014 10:16:56 AM Eastern Daylight Time		06/02/2014 01:59:19 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	005	0	2015	Mississippi		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S2505	007	0		29	10	S2505_007_0	4		1	05/29/2014	2015.02	05/29/2014 02:58:34 PM Eastern Daylight Time		06/02/2014 01:59:30 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	007	0	2015	South Carolina		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S2505	009	0		29	10	S2505_009_0	4		1	05/29/2014	2015.02	05/29/2014 03:00:25 PM Eastern Daylight Time		06/02/2014 02:51:07 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	009	0	2015	Virginia		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S2505	010	0		29	10	S2505_010_0	4		1	05/29/2014	2015.02	05/29/2014 03:01:47 PM Eastern Daylight Time		06/02/2014 01:59:52 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WINDSOR HEALTH PLAN, INC.	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S2505	010	0	2015	Missouri		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S2874	001	0		29	10	S2874_001_0	2		1	05/23/2014	2015.02	05/23/2014 03:15:27 PM Eastern Daylight Time		07/16/2014 09:47:40 AM Eastern Daylight Time			07/16/2014 10:21:25 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S2874	001	0	2015	Puerto Rico - Island Wide		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-												
S2874	004	0		29	10	S2874_004_0	4		1	05/22/2014	2015.02	05/22/2014 05:35:43 PM Eastern Daylight Time		07/16/2014 09:47:38 AM Eastern Daylight Time			07/16/2014 10:21:25 AM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S2874	004	0	2015	Puerto Rico - Island Wide		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-												
S2874	801	0		29	10	S2874_801_0	1		1	05/28/2014	2015.02	05/28/2014 03:55:30 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer (PDP)	10	29					S2874	801	0	2015	Puerto Rico - Island Wide		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-												
S2874	802	0		29	10	S2874_802_0	1		1	05/27/2014	2015.02	05/27/2014 01:35:34 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer Non-CY (PDP)	10	29					S2874	802	0	2015	Puerto Rico - Island Wide		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-												
S2874	803	0		29	10	S2874_803_0	1		1	05/27/2014	2015.02	05/27/2014 01:31:40 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE OF PUERTO RICO, INC.	Humana Insurance of Puerto Rico, Inc.	www.humana-medicare.com	Humana Medicare Employer - Walmart (PDP)	10	29					S2874	803	0	2015	Puerto Rico - Island Wide		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(866)773-5959		(866)773-5959		(800)681-3625		(800)681-3625										(711)-		(711)-		(711)-		(711)-												
S2893	001	0		29	10	S2893_001_0	2		1	05/31/2014	2015.01	05/31/2014 10:31:05 AM Eastern Daylight Time		05/29/2014 06:58:47 PM Eastern Daylight Time			05/31/2014 06:22:51 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Value Plus (PDP)	10	29					S2893	001	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.rxmedicareplans.com	www.rxmedicareplans.com									(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069												
S2893	003	0		29	10	S2893_003_0	2		1	05/30/2014	2015.01	05/30/2014 05:18:15 PM Eastern Daylight Time		05/29/2014 06:58:55 PM Eastern Daylight Time			05/31/2014 06:34:38 PM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx Premier (PDP)	10	29					S2893	003	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.rxmedicareplans.com	www.rxmedicareplans.com									(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069												
S2893	801	0		29	10	S2893_801_0	1		1	05/29/2014	2015.01	05/29/2014 02:41:12 PM Eastern Daylight Time					05/30/2014 10:31:41 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx (PDP)	10	29					S2893	801	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		1					2								www.rxmedicareplans.com	www.rxmedicareplans.com									(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069												
S2893	802	0		29	10	S2893_802_0	1		1	05/28/2014	2015.01	05/28/2014 12:40:16 PM Eastern Daylight Time					05/30/2014 10:33:47 AM Eastern Daylight Time	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	Blue MedicareRx	www.RxMedicarePlans.com	Blue MedicareRx (PDP)	10	29					S2893	802	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		1					2								www.rxmedicareplans.com	www.rxmedicareplans.com									(888)543-4917		(888)543-4917		(877)479-2227		(877)479-2227										(866)236-1069		(866)236-1069		(866)236-1069		(866)236-1069												
S3389	802	0		29	10	S3389_802_0	1		1	05/19/2014	2015.01	05/19/2014 09:54:01 AM Eastern Daylight Time					06/02/2014 09:10:26 AM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	802	0	2015	States of Pennsylvania and West Virginia		1					2								http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html									(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629												
S3389	803	0		29	10	S3389_803_0	1		1	05/16/2014	2015.01	05/16/2014 02:10:49 PM Eastern Daylight Time					06/02/2014 09:10:26 AM Eastern Daylight Time	UPMC HEALTH BENEFITS, INC.	UPMC Health Plan	http://www.upmchealthplan.com/medicare/	UPMC Employer Group (PDP)	10	29					S3389	803	0	2015	States of Pennsylvania and West Virginia		1					2								http://www.upmchealthplan.com/medicare/partd.html	http://www.upmchealthplan.com/medicare/partd.html									(877)539-3080		(877)539-3080		(877)381-3765		(877)381-3765										(800)361-2629		(800)361-2629		(800)361-2629		(800)361-2629												
S3440	004	0		29	10	S3440_004_0	4		1	05/29/2014	2015.01	05/29/2014 02:46:54 PM Eastern Daylight Time		05/30/2014 05:35:20 PM Eastern Daylight Time			06/02/2014 02:52:42 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare Rx	www.hap.org/Medicare	Alliance Medicare RX (PDP)	10	29					S3440	004	0	2015	Alliance Medicare RX-Michigan		2					2								www.hap.org/medicare	www.hap.org/medicare									(800)765-3436		(313)664-9064		(800)765-3436		(800)765-3436										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777												
S3440	801	0		29	10	S3440_801_0	4		1	05/08/2014	2015.01	05/08/2014 01:25:17 PM Eastern Daylight Time					06/02/2014 02:52:42 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare Rx	www.hap.org	Alliance Medicare Rx (Employer Only) CY (PDP)	10	29					S3440	801	0	2015	Alliance Medicare Rx - Michigan (Employer Only) CY		1					2								www.hap.org/medicare	www.hap.org/medicare									(800)765-3436		(313)664-9064		(800)765-3436		(800)765-3436										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777												
S3440	802	0		29	10	S3440_802_0	4		1	05/08/2014	2015.01	05/08/2014 01:25:25 PM Eastern Daylight Time					06/02/2014 02:52:42 PM Eastern Daylight Time	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Alliance Medicare Rx	www.hap.org	Alliance Medicare Rx - (Employer Only) NCY (PDP)	10	29					S3440	802	0	2015	Alliance Medicare Rx - Michigan (Employer Only)NCY		1					2								www.hap.org/medicare	www.hap.org/medicare									(800)765-3436		(313)664-9064		(800)765-3436		(800)765-3436										(800)649-3777		(800)649-3777		(800)649-3777		(800)649-3777												
S3474	801	0		29	10	S3474_801_0	7		1	05/31/2014	2015.01	05/31/2014 08:03:17 PM Eastern Daylight Time					06/01/2014 08:58:51 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	www.Benecardpbf.com	Heartland EGWP (PDP)	10	29					S3474	801	0	2015	Benecard Services, Inc.		1					2							www.Benecardpbf.com	www.Benecardpbf.com	www.Benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	802	0		29	10	S3474_802_0	7		1	05/30/2014	2015.01	05/30/2014 08:52:42 AM Eastern Daylight Time					06/01/2014 10:53:53 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	www.Benecardpbf.com	Heartland EGWP (PDP)	10	29					S3474	802	0	2015	Benecard Services, Inc.		1					2							www.Benecardpbf.com	www.Benecardpbf.com	www.Benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	804	0		29	10	S3474_804_0	6		1	05/31/2014	2015.01	05/31/2014 08:03:59 PM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW4 Client 1 (PDP)	10	29					S3474	804	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	805	0		29	10	S3474_805_0	6		1	05/31/2014	2015.01	05/31/2014 08:04:35 PM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW4 Client 2 (PDP)	10	29					S3474	805	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	806	0		29	10	S3474_806_0	6		1	05/31/2014	2015.01	05/31/2014 08:10:11 PM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW4 Client 3 (PDP)	10	29					S3474	806	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	807	0		29	10	S3474_807_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:57 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW4 Client 4 (PDP)	10	29					S3474	807	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	808	0		29	10	S3474_808_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:52 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP HPAW4 (PDP)	10	29					S3474	808	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	809	0		29	10	S3474_809_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:46 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP HBAW5 (PDP)	10	29					S3474	809	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	810	0		29	10	S3474_810_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:41 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 8 (PDP)	10	29					S3474	810	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	811	0		29	10	S3474_811_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:36 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 9 (PDP)	10	29					S3474	811	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	812	0		29	10	S3474_812_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:32 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 10 (PDP)	10	29					S3474	812	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	813	0		29	10	S3474_813_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:26 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 11 (PDP)	10	29					S3474	813	0	2015	Benecars Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	814	0		29	10	S3474_814_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:21 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 12 (PDP)	10	29					S3474	814	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	815	0		29	10	S3474_815_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:16 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS  Group 13 (PDP)	10	29					S3474	815	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	816	0		29	10	S3474_816_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:12 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 14 (PDP)	10	29					S3474	816	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	817	0		29	10	S3474_817_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:06 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 15 (PDP)	10	29					S3474	817	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	818	0		29	10	S3474_818_0	6		1	05/31/2014	2015.01	05/31/2014 08:59:00 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 1 (PDP)	10	29					S3474	818	0	2015	Benecard Srvices, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	819	0		29	10	S3474_819_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:55 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW5 Client 5 (PDP)	10	29					S3474	819	0	2015	Benencard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	820	0		29	10	S3474_820_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:50 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW5 Client 6 (PDP)	10	29					S3474	820	0	2015	Benecard Serevices, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	821	0		29	10	S3474_821_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:45 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW5 Client 7 (PDP)	10	29					S3474	821	0	2015	Benecard Serevices, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	822	0		29	10	S3474_822_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:39 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP AW5 Client 8 (PDP)	10	29					S3474	822	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	823	0		29	10	S3474_823_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:35 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP HPAW4 (PDP)	10	29					S3474	823	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	824	0		29	10	S3474_824_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:30 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP HPAW5 (PDP)	10	29					S3474	824	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	825	0		29	10	S3474_825_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:24 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 8 (PDP)	10	29					S3474	825	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	826	0		29	10	S3474_826_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:18 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 9 (PDP)	10	29					S3474	826	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	827	0		29	10	S3474_827_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:13 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 10 (PDP)	10	29					S3474	827	0	2015	Brenecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	828	0		29	10	S3474_828_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:08 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 11 (PDP)	10	29					S3474	828	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	829	0		29	10	S3474_829_0	6		1	05/31/2014	2015.01	05/31/2014 08:58:03 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 12 (PDP)	10	29					S3474	829	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	830	0		29	10	S3474_830_0	6		1	05/31/2014	2015.01	05/31/2014 08:57:58 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 13 (PDP)	10	29					S3474	830	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	831	0		29	10	S3474_831_0	6		1	05/31/2014	2015.01	05/31/2014 08:57:54 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 14 (PDP)	10	29					S3474	831	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	832	0		29	10	S3474_832_0	6		1	05/31/2014	2015.01	05/31/2014 08:57:49 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 15 (PDP)	10	29					S3474	832	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	833	0		29	10	S3474_833_0	6		1	05/31/2014	2015.01	05/31/2014 08:57:42 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 16 (PDP)	10	29					S3474	833	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	834	0		29	10	S3474_834_0	6		1	05/31/2014	2015.01	05/31/2014 08:57:37 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP PBF Sponsor 17 (PDP)	10	29					S3474	834	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3474	855	0		29	10	S3474_855_0	6		1	05/31/2014	2015.01	05/31/2014 08:57:32 AM Eastern Daylight Time					06/01/2014 02:54:43 PM Eastern Daylight Time	HEARTLAND FIDELITY INSURANCE COMPANY	Benecard Services, Inc.	http://www.benecard.com	Heartland EGWP BCS Group 1 (PDP)	10	29					S3474	855	0	2015	Benecard Services, Inc.		1					2								http://www.benecardpbf.com	http://www.benecardpbf.com									(888)907-5990		(717)458-9105		(888)907-5990		(717)458-9105										(888)907-0020		(717)458-9133		(888)907-0020		(717)458-9133												
S3521	801	0		29	10	S3521_801_0	1		1	05/30/2014	2015.01	05/30/2014 03:18:24 PM Eastern Daylight Time					06/02/2014 09:29:29 AM Eastern Daylight Time	EXCELLUS HEALTH PLAN, INC.	Excellus Health Plan, Inc	www.SimplyPrescriptions.com	Simply Prescriptions- Employer Group (PDP)	10	29					S3521	801	0	2015	National and US Territories		1					2							www.SimplyPrescriptions.com	www.SimplyPrescriptions.com	www.SimplyPrescriptions.com									(800)499-2838		(800)499-2838		(800)659-1986		(800)659-1986										(800)421-1220		(800)421-1220		(800)421-1220		(800)421-1220												
S3875	802	0		29	10	S3875_802_0	2		1	05/30/2014	2015.01	05/30/2014 10:26:59 PM Mountain Daylight Time					05/30/2014 10:29:34 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance Calendar Year 2015 EGWP (PDP)	10	29					S3875	802	0	2015	Granite Alliance Calendar Year 2015 National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-												
S3875	803	0		29	10	S3875_803_0	2		1	05/30/2014	2015.01	05/30/2014 10:27:03 PM Mountain Daylight Time					05/30/2014 10:29:34 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance non-calendar year 2015 EGWP (PDP)	10	29					S3875	803	0	2015	Granite Alliance non-calendar 2015 National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-												
S3875	804	0		29	10	S3875_804_0	2		1	05/30/2014	2015.01	05/30/2014 10:27:08 PM Mountain Daylight Time					05/30/2014 10:29:34 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance WD CY 2015 National EGWP (PDP)	10	29					S3875	804	0	2015	Granite Alliance WD CY 2015 National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-												
S3875	805	0		29	10	S3875_805_0	2		1	05/30/2014	2015.01	05/30/2014 10:27:12 PM Mountain Daylight Time					05/30/2014 10:29:34 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance WD Non-CY 2015 National EGWP (PDP)	10	29					S3875	805	0	2015	Granite Alliance WD Non-CY 2015 National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-												
S3875	806	0		29	10	S3875_806_0	2		1	05/30/2014	2015.01	05/30/2014 10:27:17 PM Mountain Daylight Time					05/30/2014 10:29:34 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance Other CY 2015 National EGWP (PDP)	10	29					S3875	806	0	2015	Granite Alliance Other CY 2015 National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-												
S3875	807	0		29	10	S3875_807_0	2		1	05/30/2014	2015.01	05/30/2014 10:27:22 PM Mountain Daylight Time					05/30/2014 10:29:34 PM Mountain Daylight Time	GRANITE ALLIANCE INSURANCE COMPANY	Granite Alliance	www.mygraniterx.com	Granite Alliance Other Non-CY 2015 National EGWP (PDP)	10	29					S3875	807	0	2015	Granite Alliance Other Non-CY 2015 National EGWP		1					2								www.mygraniterx.com	www.mygraniterx.com									(855)586-2573		(801)503-3850		(855)586-2573		(801)503-3850										(711)-		(711)-		(711)-		(711)-												
S3994	801	0		29	10	S3994_801_0	1		1	05/30/2014	2015.01	05/30/2014 03:34:50 PM Hawaiian Standard Time					05/30/2014 03:35:09 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSA's Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP CY (PDP)	10	29					S3994	801	0	2015	National		1					2								www.hmsa.com	www.hmsa.com									(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-												
S3994	802	0		29	10	S3994_802_0	1		1	05/30/2014	2015.01	05/30/2014 03:34:55 PM Hawaiian Standard Time					05/30/2014 03:42:28 PM Hawaiian Standard Time	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	HMSA's Medicare Rx Plan	www.hmsa.com	Medicare Rx EGWP NCY (PDP)	10	29					S3994	802	0	2015	National		1					2								www.hmsa.com	www.hmsa.com									(800)776-4672		(808)948-6000		(800)620-4672		(808)948-5555										(711)-		(711)-		(711)-		(711)-												
S4054	001	0		29	10	S4054_001_0	2		1	07/16/2014	2015.01	07/16/2014 10:30:21 PM Pacific Daylight Time		07/15/2014 11:40:23 AM Pacific Daylight Time			07/16/2014 10:46:36 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Medicare Rx Standard (PDP)	10	29					S4054	001	0	2015	State of Nevada		2					2							www.SeniorCarePlus.com	www.SeniorCarePlus.com	www.SeniorCarePlus.com									(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-												
S4054	002	0		29	10	S4054_002_0	1		1	06/02/2014	2015.01	06/02/2014 07:18:18 PM Pacific Daylight Time		06/02/2014 05:43:13 PM Pacific Daylight Time			06/02/2014 07:51:18 PM Pacific Daylight Time	HOMETOWN HEALTH PLAN	Senior Care Plus	www.SeniorCarePlus.com	Senior Care Plus: Medicare Rx Choice (PDP)	10	29					S4054	002	0	2015	State of Nevada		2					2								www.SeniorCarePlus.com	www.SeniorCarePlus.com									(800)681-9585		(775)982-3112		(888)775-7003		(775)982-3158										(711)-		(711)-		(711)-		(711)-												
S4219	003	0		29	10	S4219_003_0	1		1	05/28/2014	2015.01	05/28/2014 03:19:38 PM Central Daylight Time		05/31/2014 08:31:52 PM Central Daylight Time			06/01/2014 07:40:21 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.Healthalliancemedicare.org	Health Alliance Medicare Prescription Plan - Basic (PDP)	10	29					S4219	003	0	2015	State of Illinois		2					2							www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(855)291-9311		(855)291-9311										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844												
S4219	801	0		29	10	S4219_801_0	1		1	05/27/2014	2015.01	05/27/2014 09:01:36 AM Central Daylight Time					06/01/2014 07:40:21 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.Healthalliancemedicare.org	Health Alliance Group Medicare Prescription Plan (PDP)	10	29					S4219	801	0	2015	United States		1					2							www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(855)291-9311		(855)291-9311										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844												
S4219	802	0		29	10	S4219_802_0	1		1	05/27/2014	2015.01	05/27/2014 09:01:41 AM Central Daylight Time					06/01/2014 07:40:21 PM Central Daylight Time	HEALTH ALLIANCE MEDICAL PLANS	Health Alliance Medicare Prescription Plan	www.Healthalliancemedicare.org	Medicare Employer PDP (PDP) - non calendar year (PDP)	10	29					S4219	802	0	2015	United States		1					2							www.Healthalliancemedicare.org	www.Healthalliancemedicare.org	www.Healthalliancemedicare.org									(855)291-9311		(855)291-9311		(855)291-9311		(855)291-9311										(800)526-0844		(800)526-0844		(800)526-0844		(800)526-0844												
S4501	801	0		29	10	S4501_801_0	1		1	05/30/2014	2015.01	05/30/2014 01:55:26 PM Eastern Daylight Time					05/30/2014 01:58:20 PM Eastern Daylight Time	INDEPENDENT HEALTH BENEFITS CORPORATION	Independent Healths Medicare Retiree PDP	www.independenthealth.com	Independent Health's Medicare Retiree Rx (PDP)	10	29					S4501	801	0	2015	LMHF Program		1					2								www.independenthealth.com	www.pbdrx.com									(800)665-1502		(716)250-4401		(800)958-4405		(716)635-4900										(800)432-1110		(716)631-3108		(888)357-9167		(716)635-4840												
S4802	012	0		29	10	S4802_012_0	4		1	05/29/2014	2015.02	05/29/2014 03:03:36 PM Eastern Daylight Time		06/02/2014 02:00:04 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	012	0	2015	Louisiana		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S4802	013	0		29	10	S4802_013_0	4		1	05/30/2014	2015.02	05/30/2014 10:17:47 AM Eastern Daylight Time		06/02/2014 02:00:15 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	013	0	2015	Texas		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S4802	014	0		29	10	S4802_014_0	4		1	05/29/2014	2015.02	05/29/2014 03:07:32 PM Eastern Daylight Time		06/02/2014 02:00:26 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	014	0	2015	Oklahoma		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S4802	020	0		29	10	S4802_020_0	4		1	05/29/2014	2015.02	05/29/2014 03:08:43 PM Eastern Daylight Time		06/02/2014 02:00:37 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	020	0	2015	Oregon and Washington		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S4802	021	0		29	10	S4802_021_0	4		1	05/29/2014	2015.02	05/29/2014 03:09:57 PM Eastern Daylight Time		06/02/2014 02:00:47 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.wellcarepdp.com	WellCare Simple (PDP)	10	29					S4802	021	0	2015	Idaho and Utah		2					2								www.WindsorRx.com	www.WindsorRx.com									(800)316-2273		(800)316-2273		(888)900-4307		(888)900-4307										(711)-		(711)-		(888)816-5252		(888)816-5252												
S4802	801	0		29	10	S4802_801_0	2		1	05/30/2014	2015.02	05/30/2014 10:19:57 AM Eastern Daylight Time					05/31/2014 11:54:32 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.sterlingretireescripts.com	Sterling Retiree Rx (PDP)	10	29					S4802	801	0	2015	Nationwide		1					2								www.sterlingretireescripts.com	www.sterlingretireescripts.com									(800)313-7667		(800)313-7667		(800)313-7667		(800)313-7667										(711)-		(711)-		(711)-		(711)-												
S4802	805	0		29	10	S4802_805_0	1		1	05/31/2014	2015.02	05/31/2014 08:36:55 PM Eastern Daylight Time					05/31/2014 11:54:32 PM Eastern Daylight Time	STERLING LIFE INSURANCE COMPANY	WellCare	www.sterlingretireescripts.com	Sterling Retiree Rx (PDP)	10	29					S4802	805	0	2015	Nationwide		1					2								www.sterlingretireescripts.com	www.sterlingretireescripts.com									(800)313-7667		(800)313-7667		(800)313-7667		(800)313-7667										(711)-		(711)-		(711)-		(711)-												
S5351	801	0		29	10	S5351_801_0	3		1	05/24/2014	2015.01	05/24/2014 02:06:03 PM Pacific Daylight Time					06/02/2014 04:43:43 PM Pacific Daylight Time	PACIFICSOURCE COMMUNITY HEALTH PLANS, INC.	PacificSource Medicare	www.Medicare.PacificSource.com	PacificSource Medicare 801 (PDP)	10	29					S5351	801	0	2015	Nationwide		1					2								http://medicare.pacificsource.com/Tools/DrugSearch.aspx	http://medicare.pacificsource.com/Tools/PharmacySearch.aspx									(888)863-3637		(541)385-5315		(888)863-3637		(541)385-5315										(800)735-2900		(800)735-2900		(800)735-2900		(800)735-2900												
S5540	002	0		29	10	S5540_002_0	3		1	05/29/2014	2015.01	05/29/2014 04:49:03 PM Eastern Daylight Time		07/28/2014 02:03:12 PM Eastern Daylight Time			07/28/2014 03:22:06 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare Rx Standard (PDP)	10	29					S5540	002	0	2015	North Carolina		2					2								http://www.bcbsnc.com/content/medicare/formulary-home.htm	http://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC									(888)247-4142		(888)247-4142		(800)478-0583		(800)478-0583										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140												
S5540	004	0		29	10	S5540_004_0	3		1	05/14/2014	2015.01	05/14/2014 03:25:42 PM Eastern Daylight Time		07/28/2014 02:03:12 PM Eastern Daylight Time			07/28/2014 03:22:06 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare Rx Enhanced (PDP)	10	29					S5540	004	0	2015	North Carolina		2					2								http://www.bcbsnc.com/content/medicare/formulary-home.htm	http://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC									(888)247-4142		(888)247-4142		(800)478-0583		(800)478-0583										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140												
S5540	801	0		29	10	S5540_801_0	1		1	05/05/2014	2015.01	05/05/2014 02:30:51 PM Eastern Daylight Time					06/02/2014 10:19:59 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Blue Cross and Blue Shield of North Carolina	www.bcbsnc.com/medicare	Blue Medicare Rx EGWP (PDP)	10	29					S5540	801	0	2015	National Employer Group Retirees		1					2								http://www.bcbsnc.com/content/medicare/formulary-home.htm	http://www.myprime.com/MyRx/MyPrime/MedicareD/pharmacy/BCBSNC									(888)247-4142		(888)247-4142		(800)478-0583		(800)478-0583										(888)247-4145		(888)247-4145		(800)922-3140		(800)922-3140												
S5552	003	0		29	10	S5552_003_0	2		1	07/21/2014	2015.02	07/21/2014 12:38:19 PM Eastern Daylight Time		07/22/2014 06:34:06 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5552	003	0	2015	State of New York		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5552	004	0		29	10	S5552_004_0	1		1	05/21/2014	2015.02	05/21/2014 04:08:28 PM Eastern Daylight Time		05/27/2014 05:03:49 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5552	004	0	2015	State of New York		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5552	005	0		29	10	S5552_005_0	2		1	07/21/2014	2015.02	07/21/2014 12:39:08 PM Eastern Daylight Time		07/22/2014 06:34:06 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5552	005	0	2015	State of New York		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5552	801	0		29	10	S5552_801_0	1		1	05/27/2014	2015.02	05/27/2014 01:32:46 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer (PDP)	10	29					S5552	801	0	2015	State of New York		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5552	802	0		29	10	S5552_802_0	1		1	05/27/2014	2015.02	05/27/2014 01:35:09 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer Non-CY (PDP)	10	29					S5552	802	0	2015	State of New York		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5552	803	0		29	10	S5552_803_0	1		1	05/27/2014	2015.02	05/27/2014 01:33:08 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY OF NEW YORK	Humana Insurance Company of New York	www.humana-medicare.com	Humana Medicare Employer - Walmart (PDP)	10	29					S5552	803	0	2015	State of New York		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5569	006	0		29	10	S5569_006_0	2		1	05/25/2014	2015.01	05/25/2014 04:31:29 PM Eastern Daylight Time		05/30/2014 05:36:30 PM Eastern Daylight Time			05/31/2014 12:43:59 PM Eastern Daylight Time	CAMBRIDGE LIFE INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5569	006	0	2015	First Health Part D Value Plus - New York		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5569	008	0		29	10	S5569_008_0	3		1	07/02/2014	2015.01	07/02/2014 10:40:25 AM Eastern Daylight Time		05/30/2014 05:36:39 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	CAMBRIDGE LIFE INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5569	008	0	2015	New York		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5580	003	0		29	10	S5580_003_0	4		1	06/30/2014	2015.01	06/30/2014 03:23:40 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First United American - Enhanced (PDP)	10	29					S5580	003	0	2015	State of New York		2					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4171		(866)524-4171		(877)723-6067		(877)723-6067										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5580	006	0		29	10	S5580_006_0	3		1	05/30/2014	2015.01	05/30/2014 09:08:16 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First United American - Select (PDP)	10	29					S5580	006	0	2015	State of New York		2					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4171		(866)524-4171		(877)723-6067		(877)723-6067										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5580	007	0		29	10	S5580_007_0	4		1	06/30/2014	2015.01	06/30/2014 02:09:21 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First United American - Essential (PDP)	10	29					S5580	007	0	2015	State of New York		2					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4171		(866)524-4171		(877)723-6067		(877)723-6067										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5580	801	0		29	10	S5580_801_0	2		1	04/14/2014	2015.01	04/14/2014 11:32:00 AM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA Employer Calendar Drug Plan (PDP)	10	29					S5580	801	0	2015	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5580	802	0		29	10	S5580_802_0	2		1	04/14/2014	2015.01	04/14/2014 11:32:06 AM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA Employer Non-Calendar Drug Plan (PDP)	10	29					S5580	802	0	2015	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5580	805	0		29	10	S5580_805_0	2		1	04/14/2014	2015.01	04/14/2014 11:32:11 AM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA EGWP-Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5580	805	0	2015	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5580	806	0		29	10	S5580_806_0	2		1	04/14/2014	2015.01	04/14/2014 11:32:16 AM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	FIRST UNITED AMERICAN LIFE INSURANCE COMPANY	First United American Life Insurance Company	www.firstuamedicarepartd.com	First UA EGWP-Non-Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5580	806	0	2015	National		1					2								http://www.firstuamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.firstuamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)412-8499		(866)412-8499		(866)412-8499		(866)412-8499										(866)524-4172		(866)524-4172		(866)524-4172		(866)524-4172												
S5584	001	0		29	10	S5584_001_0	7		1	05/30/2014	2015.01	05/30/2014 12:38:40 PM Eastern Daylight Time		06/01/2014 03:05:30 PM Eastern Daylight Time			06/02/2014 08:14:02 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Option A (PDP)	10	29					S5584	001	0	2015	State of Michigan		2					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-												
S5584	002	0		29	10	S5584_002_0	7		1	05/30/2014	2015.01	05/30/2014 12:38:52 PM Eastern Daylight Time		06/01/2014 03:06:00 PM Eastern Daylight Time			06/02/2014 08:14:02 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Option B (PDP)	10	29					S5584	002	0	2015	State of Michigan		2					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-												
S5584	801	0		29	10	S5584_801_0	7		1	05/30/2014	2015.01	05/30/2014 12:39:03 PM Eastern Daylight Time					06/02/2014 08:14:02 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Employer Plan CY (PDP)	10	29					S5584	801	0	2015	State of Michigan		1					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-												
S5584	802	0		29	10	S5584_802_0	7		1	05/30/2014	2015.01	05/30/2014 12:39:14 PM Eastern Daylight Time					06/02/2014 08:14:02 PM Eastern Daylight Time	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Blue Cross Blue Shield of Michigan	www.bcbsm.com/medicare	Prescription Blue Employer Plan non-CY (PDP)	10	29					S5584	802	0	2015	State of Michigan		1					2								www.bcbsm.com/formularymedicare	www.bcbsm.com/pharmaciesmedicare									(800)565-1770		(800)565-1770		(888)563-3307		(888)563-3307										(711)-		(711)-		(711)-		(711)-												
S5588	802	0		29	10	S5588_802_0	1		1	05/29/2014	2015.01	05/29/2014 01:23:57 PM Eastern Daylight Time					05/29/2014 05:02:00 PM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	www.paramounthealthcare.com	Paramount Std. Prescription Drug Plan Empl (PDP)	10	29					S5588	802	0	2015	Paramount Standard Prescription Drug Plan (Ohio)		1					2								www.paramounthealthcare.com/medicareplans	www.paramounthealthcare.com/medicareplans									(800)462-3589		(419)887-2525		(800)462-3589		(800)462-3589										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670												
S5588	803	0		29	10	S5588_803_0	1		1	05/27/2014	2015.01	05/27/2014 01:44:49 PM Eastern Daylight Time					05/29/2014 05:02:00 PM Eastern Daylight Time	PARAMOUNT INSURANCE COMPANY	Paramount Prescription Drug Plan	www.paramounthealthcare.com	Paramount Enh. Prescription Drug Plan Empl (PDP)	10	29					S5588	803	0	2015	Paramount Enhanced Prescription Drug Plan (Ohio)		1					2								www.paramounthealthcare.com/medicareplans	www.paramounthealthcare.com/medicareplans									(800)462-3589		(419)887-2525		(800)462-3589		(800)462-3589										(888)740-5670		(888)740-5670		(888)740-5670		(888)740-5670												
S5593	002	0		29	10	S5593_002_0	6		1	06/09/2014	2015.01	06/09/2014 08:42:08 AM Eastern Daylight Time		06/09/2014 08:41:11 AM Eastern Daylight Time			06/09/2014 08:47:24 AM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	http://www.hmhealthinsurance.com	Blue Rx Plus (PDP)	10	29					S5593	002	0	2015	Pennsylvania  and West Virginia		2					2								http://client.formularynavigator.com/clients/hm/default.html	http://www.hmhealthinsurance.com									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210												
S5593	003	0		29	10	S5593_003_0	5		1	06/09/2014	2015.01	06/09/2014 08:42:18 AM Eastern Daylight Time		06/09/2014 08:41:11 AM Eastern Daylight Time			06/09/2014 08:47:24 AM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	http://www.hmhealthinsurance.com	Blue Rx Complete (PDP)	10	29					S5593	003	0	2015	Pennsylvania  and West Virginia		2					2								http://client.formularynavigator.com/clients/hm/default.html	http://www.hmhealthinsurance.com									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210												
S5593	801	0		29	10	S5593_801_0	4		1	05/29/2014	2015.01	05/29/2014 07:29:51 AM Eastern Daylight Time					05/31/2014 02:51:57 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	http://www.hmhealthinsurance.com	Blue Rx Employer Group Calendar (PDP)	10	29					S5593	801	0	2015	National		1					2								http://client.formularynavigator.com/clients/hm/default.html	http://www.hmhealthinsurance.com									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210												
S5593	802	0		29	10	S5593_802_0	4		1	05/29/2014	2015.01	05/29/2014 07:29:57 AM Eastern Daylight Time					05/31/2014 02:51:57 PM Eastern Daylight Time	HM HEALTH INSURANCE COMPANY	HM Health Insurance Company	http://www.hmhealthinsurance.com	Blue Rx Employer Group Non-Calendar (PDP)	10	29					S5593	802	0	2015	National		1					2								http://client.formularynavigator.com/clients/hm/default.html	http://www.hmhealthinsurance.com									(800)290-3914		(800)290-3914		(866)435-1047		(866)435-1047										(711)-		(711)-		(800)227-8210		(800)227-8210												
S5596	001	0		29	10	S5596_001_0	5		1	05/30/2014	2015.01	05/30/2014 09:53:15 AM Eastern Daylight Time		06/24/2014 02:41:25 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	001	0	2015	Maine and New Hampshire		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	003	0		29	10	S5596_003_0	5		1	05/30/2014	2015.01	05/30/2014 09:55:56 AM Eastern Daylight Time		06/24/2014 02:41:29 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	003	0	2015	Maine and New Hampshire		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	005	0		29	10	S5596_005_0	6		1	05/30/2014	2015.01	05/30/2014 09:56:56 AM Eastern Daylight Time		06/24/2014 02:41:34 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	005	0	2015	Virginia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	006	0		29	10	S5596_006_0	7		1	05/30/2014	2015.01	05/30/2014 09:58:09 AM Eastern Daylight Time		07/09/2014 05:54:24 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	006	0	2015	Virginia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	007	0		29	10	S5596_007_0	6		1	05/30/2014	2015.01	05/30/2014 09:59:24 AM Eastern Daylight Time		06/24/2014 02:41:46 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	007	0	2015	Virginia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	009	0		29	10	S5596_009_0	5		1	05/30/2014	2015.01	05/30/2014 10:00:22 AM Eastern Daylight Time		06/24/2014 02:41:51 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.bcbsga.com/medicare	BCBSGa Blue MedicareRx Standard (PDP)	10	29					S5596	009	0	2015	Georgia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	010	0		29	10	S5596_010_0	5		1	05/30/2014	2015.01	05/30/2014 10:01:58 AM Eastern Daylight Time		06/24/2014 02:41:56 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.bcbsga.com/medicare	BCBSGa Blue MedicareRx Plus (PDP)	10	29					S5596	010	0	2015	Georgia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	011	0		29	10	S5596_011_0	5		1	05/30/2014	2015.01	05/30/2014 10:02:56 AM Eastern Daylight Time		06/24/2014 02:42:01 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.bcbsga.com/medicare	BCBSGa Blue MedicareRx Premier (PDP)	10	29					S5596	011	0	2015	Georgia		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	013	0		29	10	S5596_013_0	5		1	05/30/2014	2015.01	05/30/2014 10:03:59 AM Eastern Daylight Time		06/24/2014 02:42:06 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	013	0	2015	Ohio		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	014	0		29	10	S5596_014_0	6		1	05/30/2014	2015.01	05/30/2014 10:05:26 AM Eastern Daylight Time		07/09/2014 05:54:35 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	014	0	2015	Ohio		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	015	0		29	10	S5596_015_0	5		1	05/30/2014	2015.01	05/30/2014 10:06:21 AM Eastern Daylight Time		06/24/2014 02:42:16 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	015	0	2015	Ohio		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	017	0		29	10	S5596_017_0	5		1	05/30/2014	2015.01	05/30/2014 10:11:24 AM Eastern Daylight Time		06/24/2014 02:42:22 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	017	0	2015	Indiana and Kentucky		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	018	0		29	10	S5596_018_0	6		1	05/30/2014	2015.01	05/30/2014 10:12:48 AM Eastern Daylight Time		07/09/2014 05:54:40 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	018	0	2015	Indiana and Kentucky		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	019	0		29	10	S5596_019_0	5		1	05/30/2014	2015.01	05/30/2014 10:14:02 AM Eastern Daylight Time		06/24/2014 02:42:34 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	019	0	2015	Indiana and Kentucky		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	033	0		29	10	S5596_033_0	5		1	05/30/2014	2015.01	05/30/2014 10:28:45 AM Eastern Daylight Time		06/24/2014 02:42:40 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/ca/medicare	Anthem Blue Cross MedicareRx Standard (PDP)	10	29					S5596	033	0	2015	California		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	034	0		29	10	S5596_034_0	6		1	05/30/2014	2015.01	05/30/2014 10:30:34 AM Eastern Daylight Time		07/09/2014 05:54:45 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/ca/medicare	Anthem Blue Cross MedicareRx Plus (PDP)	10	29					S5596	034	0	2015	California		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	035	0		29	10	S5596_035_0	5		1	05/30/2014	2015.01	05/30/2014 10:31:57 AM Eastern Daylight Time		06/24/2014 02:42:51 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/ca/medicare	Anthem Blue Cross MedicareRx Gold (PDP)	10	29					S5596	035	0	2015	California		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(800)928-6201		(800)928-6201		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	043	0		29	10	S5596_043_0	5		1	05/30/2014	2015.01	05/30/2014 10:34:46 AM Eastern Daylight Time		06/24/2014 02:42:56 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx Value (PDP)	10	29					S5596	043	0	2015	Missouri		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	044	0		29	10	S5596_044_0	6		1	05/30/2014	2015.01	05/30/2014 10:36:37 AM Eastern Daylight Time		07/09/2014 05:54:50 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx Plus (PDP)	10	29					S5596	044	0	2015	Missouri		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	045	0		29	10	S5596_045_0	5		1	05/30/2014	2015.01	05/30/2014 10:37:43 AM Eastern Daylight Time		06/24/2014 02:43:07 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx Premier (PDP)	10	29					S5596	045	0	2015	Missouri		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	046	0		29	10	S5596_046_0	5		1	05/30/2014	2015.01	05/30/2014 10:41:52 AM Eastern Daylight Time		06/24/2014 02:43:12 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	046	0	2015	Maine and New Hampshire		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	056	0		29	10	S5596_056_0	5		1	05/30/2014	2015.01	05/30/2014 10:44:51 AM Eastern Daylight Time		06/24/2014 02:43:17 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	056	0	2015	Wisconsin		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	057	0		29	10	S5596_057_0	6		1	05/30/2014	2015.01	05/30/2014 10:45:58 AM Eastern Daylight Time		07/09/2014 05:54:55 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	057	0	2015	Wisconsin		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	058	0		29	10	S5596_058_0	5		1	05/30/2014	2015.01	05/30/2014 10:47:31 AM Eastern Daylight Time		06/24/2014 02:43:28 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	058	0	2015	Wisconsin		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	059	0		29	10	S5596_059_0	6		1	05/30/2014	2015.01	05/30/2014 10:48:30 AM Eastern Daylight Time		06/24/2014 02:43:33 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	059	0	2015	Colorado		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	060	0		29	10	S5596_060_0	5		1	05/30/2014	2015.01	05/30/2014 10:49:36 AM Eastern Daylight Time		06/24/2014 02:43:39 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	060	0	2015	Colorado		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	061	0		29	10	S5596_061_0	5		1	05/30/2014	2015.01	05/30/2014 10:50:37 AM Eastern Daylight Time		06/24/2014 02:43:44 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	061	0	2015	Colorado		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	062	0		29	10	S5596_062_0	5		1	05/30/2014	2015.01	05/30/2014 10:51:44 AM Eastern Daylight Time		06/24/2014 02:48:44 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Standard (PDP)	10	29					S5596	062	0	2015	Nevada		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	063	0		29	10	S5596_063_0	6		1	05/30/2014	2015.01	05/30/2014 10:52:52 AM Eastern Daylight Time		07/09/2014 05:55:05 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Plus (PDP)	10	29					S5596	063	0	2015	Nevada		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	064	0		29	10	S5596_064_0	5		1	05/30/2014	2015.01	05/30/2014 10:53:58 AM Eastern Daylight Time		07/07/2014 02:17:55 PM Eastern Daylight Time			07/16/2014 11:36:39 AM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Anthem Blue MedicareRx Premier (PDP)	10	29					S5596	064	0	2015	Nevada		2					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)755-2776		(866)755-2776		(800)261-8667		(800)261-8667										(711)-		(711)-		(711)-		(711)-												
S5596	803	0		29	10	S5596_803_0	3		1	05/28/2014	2015.01	05/28/2014 09:16:53 PM Eastern Daylight Time					05/30/2014 04:57:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	803	0	2015	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-												
S5596	804	0		29	10	S5596_804_0	3		1	05/28/2014	2015.01	05/28/2014 09:16:57 PM Eastern Daylight Time					05/30/2014 04:57:42 PM Eastern Daylight Time	ANTHEM INSURANCE COMPANIES, INC.	Blue MedicareRx	www.anthem.com/medicare	Blue MedicareRx (PDP)	10	29					S5596	804	0	2015	VA GA OH IN KY WI CO NV CA MO ME NH (Nationwide)		1					2								www.anthem.com/medicare	www.anthem.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-												
S5601	002	0		29	10	S5601_002_0	5		1	06/30/2014	2015.01	06/30/2014 06:00:42 PM Eastern Daylight Time		07/17/2014 08:53:43 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	002	0	2015	Northern New England SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	003	0		29	10	S5601_003_0	3		1	05/23/2014	2015.01	05/23/2014 02:04:38 PM Eastern Daylight Time		07/17/2014 09:45:40 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	003	0	2015	Northern New England SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	004	0		29	10	S5601_004_0	3		1	05/23/2014	2015.01	05/23/2014 02:20:38 PM Eastern Daylight Time		07/17/2014 08:54:57 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	004	0	2015	Central New England SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	005	0		29	10	S5601_005_0	3		1	05/23/2014	2015.01	05/23/2014 03:57:00 PM Eastern Daylight Time		07/16/2014 05:52:49 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	005	0	2015	Central New England SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	006	0		29	10	S5601_006_0	3		1	05/23/2014	2015.01	05/23/2014 02:22:13 PM Eastern Daylight Time		07/17/2014 08:56:35 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	006	0	2015	New York SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	007	0		29	10	S5601_007_0	3		1	07/01/2014	2015.01	07/01/2014 10:27:25 AM Eastern Daylight Time		07/17/2014 02:15:12 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	007	0	2015	New York SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	008	0		29	10	S5601_008_0	3		1	05/23/2014	2015.01	05/23/2014 02:23:24 PM Eastern Daylight Time		07/16/2014 05:06:41 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	008	0	2015	New Jersey SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	009	0		29	10	S5601_009_0	3		1	05/23/2014	2015.01	05/23/2014 04:03:15 PM Eastern Daylight Time		07/17/2014 02:20:05 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	009	0	2015	New Jersey SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	010	0		29	10	S5601_010_0	3		1	05/23/2014	2015.01	05/23/2014 02:24:28 PM Eastern Daylight Time		07/17/2014 08:57:50 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	010	0	2015	Mid-Atlantic SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	011	0		29	10	S5601_011_0	3		1	05/23/2014	2015.01	05/23/2014 04:03:36 PM Eastern Daylight Time		07/17/2014 02:17:57 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	011	0	2015	Mid-Atlantic SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	012	0		29	10	S5601_012_0	3		1	05/23/2014	2015.01	05/23/2014 02:25:28 PM Eastern Daylight Time		07/17/2014 08:59:20 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	012	0	2015	Pennsylvania, West Virginia SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	013	0		29	10	S5601_013_0	3		1	07/01/2014	2015.01	07/01/2014 10:27:37 AM Eastern Daylight Time		07/17/2014 02:20:30 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	013	0	2015	Pennsylvania, West Virginia SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	014	0		29	10	S5601_014_0	3		1	05/23/2014	2015.01	05/23/2014 02:26:37 PM Eastern Daylight Time		07/17/2014 09:00:07 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	014	0	2015	Virginia SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	015	0		29	10	S5601_015_0	3		1	05/27/2014	2015.01	05/27/2014 08:54:52 AM Eastern Daylight Time		07/17/2014 02:14:48 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	015	0	2015	Virginia SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	016	0		29	10	S5601_016_0	3		1	05/23/2014	2015.01	05/23/2014 02:27:43 PM Eastern Daylight Time		07/17/2014 09:00:50 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	016	0	2015	North Carolina SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	017	0		29	10	S5601_017_0	3		1	05/27/2014	2015.01	05/27/2014 08:55:55 AM Eastern Daylight Time		07/17/2014 02:27:11 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	017	0	2015	North Carolina SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	018	0		29	10	S5601_018_0	3		1	05/23/2014	2015.01	05/23/2014 02:28:49 PM Eastern Daylight Time		07/17/2014 09:24:37 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	018	0	2015	South Carolina SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	019	0		29	10	S5601_019_0	3		1	05/27/2014	2015.01	05/27/2014 08:56:17 AM Eastern Daylight Time		07/17/2014 02:19:37 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	019	0	2015	South Carolina SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	020	0		29	10	S5601_020_0	3		1	05/23/2014	2015.01	05/23/2014 02:29:53 PM Eastern Daylight Time		07/17/2014 09:02:08 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	020	0	2015	Georgia SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	021	0		29	10	S5601_021_0	3		1	05/27/2014	2015.01	05/27/2014 08:56:37 AM Eastern Daylight Time		07/17/2014 02:16:11 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	021	0	2015	Georgia SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	022	0		29	10	S5601_022_0	3		1	05/23/2014	2015.01	05/23/2014 02:47:23 PM Eastern Daylight Time		07/17/2014 09:02:47 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	022	0	2015	Florida SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	023	0		29	10	S5601_023_0	3		1	05/27/2014	2015.01	05/27/2014 08:56:59 AM Eastern Daylight Time		07/17/2014 02:30:58 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	023	0	2015	Florida SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	024	0		29	10	S5601_024_0	3		1	05/23/2014	2015.01	05/23/2014 02:48:32 PM Eastern Daylight Time		07/17/2014 09:03:51 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	024	0	2015	Alabama, Tennessee SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	025	0		29	10	S5601_025_0	3		1	05/27/2014	2015.01	05/27/2014 08:57:20 AM Eastern Daylight Time		07/17/2014 02:28:14 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	025	0	2015	Alabama, Tennessee SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	026	0		29	10	S5601_026_0	3		1	05/23/2014	2015.01	05/23/2014 02:49:34 PM Eastern Daylight Time		07/17/2014 09:04:41 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	026	0	2015	Michigan SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	027	0		29	10	S5601_027_0	3		1	05/27/2014	2015.01	05/27/2014 08:57:40 AM Eastern Daylight Time		07/17/2014 02:33:26 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	027	0	2015	Michigan SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	028	0		29	10	S5601_028_0	3		1	05/23/2014	2015.01	05/23/2014 02:50:34 PM Eastern Daylight Time		07/17/2014 09:05:19 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	028	0	2015	Ohio SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	029	0		29	10	S5601_029_0	3		1	05/27/2014	2015.01	05/27/2014 08:57:59 AM Eastern Daylight Time		07/17/2014 02:31:27 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	029	0	2015	Ohio SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	030	0		29	10	S5601_030_0	3		1	05/23/2014	2015.01	05/23/2014 02:51:30 PM Eastern Daylight Time		07/17/2014 09:06:13 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	030	0	2015	Indiana, Kentucky SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	031	0		29	10	S5601_031_0	3		1	05/27/2014	2015.01	05/27/2014 08:58:18 AM Eastern Daylight Time		07/17/2014 02:33:51 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	031	0	2015	Indiana, Kentucky SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	032	0		29	10	S5601_032_0	3		1	05/23/2014	2015.01	05/23/2014 02:52:21 PM Eastern Daylight Time		07/17/2014 09:06:47 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	032	0	2015	Wisconsin SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	033	0		29	10	S5601_033_0	3		1	05/27/2014	2015.01	05/27/2014 08:58:39 AM Eastern Daylight Time		07/17/2014 02:28:38 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	033	0	2015	Wisconsin SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	034	0		29	10	S5601_034_0	3		1	05/23/2014	2015.01	05/23/2014 02:53:13 PM Eastern Daylight Time		07/17/2014 09:07:33 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	034	0	2015	Illinois SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	035	0		29	10	S5601_035_0	3		1	05/27/2014	2015.01	05/27/2014 08:58:59 AM Eastern Daylight Time		07/17/2014 02:32:30 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	035	0	2015	Illinois SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	036	0		29	10	S5601_036_0	3		1	05/23/2014	2015.01	05/23/2014 02:54:14 PM Eastern Daylight Time		07/17/2014 09:08:20 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	036	0	2015	Missouri SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	037	0		29	10	S5601_037_0	3		1	05/27/2014	2015.01	05/27/2014 08:59:20 AM Eastern Daylight Time		07/17/2014 02:30:35 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	037	0	2015	Missouri SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	038	0		29	10	S5601_038_0	3		1	05/23/2014	2015.01	05/23/2014 02:55:06 PM Eastern Daylight Time		07/17/2014 09:08:56 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	038	0	2015	Arkansas SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	040	0		29	10	S5601_040_0	3		1	05/23/2014	2015.01	05/23/2014 02:55:57 PM Eastern Daylight Time		07/17/2014 09:09:37 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	040	0	2015	Mississippi SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	041	0		29	10	S5601_041_0	3		1	05/27/2014	2015.01	05/27/2014 08:59:45 AM Eastern Daylight Time		07/17/2014 02:26:07 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	041	0	2015	Mississippi SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	042	0		29	10	S5601_042_0	3		1	05/23/2014	2015.01	05/23/2014 02:56:48 PM Eastern Daylight Time		07/17/2014 09:10:36 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	042	0	2015	Louisiana SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	044	0		29	10	S5601_044_0	3		1	05/23/2014	2015.01	05/23/2014 02:57:39 PM Eastern Daylight Time		07/17/2014 09:11:55 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	044	0	2015	Texas SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	045	0		29	10	S5601_045_0	3		1	05/27/2014	2015.01	05/27/2014 09:00:10 AM Eastern Daylight Time		07/17/2014 02:39:23 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	045	0	2015	Texas SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	046	0		29	10	S5601_046_0	3		1	05/28/2014	2015.01	05/28/2014 11:52:35 AM Eastern Daylight Time		07/17/2014 09:14:31 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	046	0	2015	Oklahoma SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	048	0		29	10	S5601_048_0	3		1	05/23/2014	2015.01	05/23/2014 02:59:19 PM Eastern Daylight Time		07/17/2014 09:15:28 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	048	0	2015	Kansas SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	049	0		29	10	S5601_049_0	3		1	05/27/2014	2015.01	05/27/2014 09:00:36 AM Eastern Daylight Time		07/17/2014 02:39:49 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	049	0	2015	Kansas SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	050	0		29	10	S5601_050_0	3		1	05/23/2014	2015.01	05/23/2014 03:00:08 PM Eastern Daylight Time		07/17/2014 09:16:40 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	050	0	2015	Upper Midwest and N. Plains SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	051	0		29	10	S5601_051_0	3		1	05/27/2014	2015.01	05/27/2014 09:01:00 AM Eastern Daylight Time		07/17/2014 02:42:36 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	051	0	2015	Upper Midwest and N. Plains SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	052	0		29	10	S5601_052_0	3		1	05/23/2014	2015.01	05/23/2014 03:01:01 PM Eastern Daylight Time		07/17/2014 09:17:40 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	052	0	2015	New Mexico SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	053	0		29	10	S5601_053_0	3		1	05/27/2014	2015.01	05/27/2014 09:01:23 AM Eastern Daylight Time		07/17/2014 10:57:31 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	053	0	2015	New Mexico SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	054	0		29	10	S5601_054_0	3		1	05/23/2014	2015.01	05/23/2014 03:01:54 PM Eastern Daylight Time		07/17/2014 09:18:55 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	054	0	2015	Colorado SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	055	0		29	10	S5601_055_0	3		1	05/27/2014	2015.01	05/27/2014 09:01:43 AM Eastern Daylight Time		07/17/2014 02:40:19 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	055	0	2015	Colorado SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	056	0		29	10	S5601_056_0	3		1	05/23/2014	2015.01	05/23/2014 03:02:45 PM Eastern Daylight Time		07/17/2014 09:20:39 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	056	0	2015	Arizona SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	057	0		29	10	S5601_057_0	3		1	05/27/2014	2015.01	05/27/2014 09:02:06 AM Eastern Daylight Time		07/17/2014 02:43:07 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	057	0	2015	Arizona SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	058	0		29	10	S5601_058_0	3		1	05/23/2014	2015.01	05/23/2014 03:03:38 PM Eastern Daylight Time		07/17/2014 01:43:49 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	058	0	2015	Nevada SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	059	0		29	10	S5601_059_0	3		1	05/27/2014	2015.01	05/27/2014 09:02:26 AM Eastern Daylight Time		07/17/2014 10:54:08 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	059	0	2015	Nevada SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	060	0		29	10	S5601_060_0	3		1	05/23/2014	2015.01	05/23/2014 03:04:28 PM Eastern Daylight Time		07/17/2014 09:24:40 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	060	0	2015	Oregon, Washington SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	061	0		29	10	S5601_061_0	3		1	05/27/2014	2015.01	05/27/2014 09:02:46 AM Eastern Daylight Time		07/17/2014 02:40:46 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	061	0	2015	Oregon, Washington SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	062	0		29	10	S5601_062_0	3		1	05/23/2014	2015.01	05/23/2014 03:05:15 PM Eastern Daylight Time		07/17/2014 09:25:45 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	062	0	2015	Idaho, Utah SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	063	0		29	10	S5601_063_0	3		1	05/27/2014	2015.01	05/27/2014 09:03:07 AM Eastern Daylight Time		07/17/2014 02:41:18 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	063	0	2015	Idaho, Utah SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	064	0		29	10	S5601_064_0	3		1	05/23/2014	2015.01	05/23/2014 03:06:06 PM Eastern Daylight Time		07/17/2014 09:27:02 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	064	0	2015	California SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	065	0		29	10	S5601_065_0	3		1	05/27/2014	2015.01	05/27/2014 09:03:28 AM Eastern Daylight Time		07/17/2014 02:43:42 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	065	0	2015	California SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	066	0		29	10	S5601_066_0	3		1	07/01/2014	2015.01	07/01/2014 10:27:53 AM Eastern Daylight Time		07/17/2014 02:11:12 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	066	0	2015	Hawaii SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	067	0		29	10	S5601_067_0	3		1	05/27/2014	2015.01	05/27/2014 09:03:48 AM Eastern Daylight Time		07/17/2014 11:03:51 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	067	0	2015	Hawaii SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	068	0		29	10	S5601_068_0	4		1	05/28/2014	2015.01	05/28/2014 12:21:26 PM Eastern Daylight Time		07/17/2014 09:29:57 AM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Choice (PDP)	10	29					S5601	068	0	2015	Alaska SilverScript Choice		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	107	0		29	10	S5601_107_0	3		1	05/27/2014	2015.01	05/27/2014 09:04:09 AM Eastern Daylight Time		07/17/2014 02:33:02 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	107	0	2015	Arkansas SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	108	0		29	10	S5601_108_0	3		1	05/28/2014	2015.01	05/28/2014 02:39:03 PM Eastern Daylight Time		07/17/2014 02:41:44 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	108	0	2015	Louisiana SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	109	0		29	10	S5601_109_0	3		1	05/27/2014	2015.01	05/27/2014 09:04:30 AM Eastern Daylight Time		07/17/2014 02:42:13 PM Eastern Daylight Time			07/17/2014 04:54:03 PM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Plus (PDP)	10	29					S5601	109	0	2015	Oklahoma SilverScript Plus		2					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	801	0		29	10	S5601_801_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:35 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 3 Tier - Calendar (PDP)	10	29					S5601	801	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	802	0		29	10	S5601_802_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:30 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 3 Tier - Non-Calendar (PDP)	10	29					S5601	802	0	2015	National SilverScript Group - Non-Calendar		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	803	0		29	10	S5601_803_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:26 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 2 Tier - Calendar (PDP)	10	29					S5601	803	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	804	0		29	10	S5601_804_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:21 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 2 Tier - Non-Calendar (PDP)	10	29					S5601	804	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	805	0		29	10	S5601_805_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:16 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 1 Tier - Calendar (PDP)	10	29					S5601	805	0	2015	National		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	806	0		29	10	S5601_806_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:12 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 1 Tier - Non Calendar (PDP)	10	29					S5601	806	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	807	0		29	10	S5601_807_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:07 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 4 Tier - Calendar (PDP)	10	29					S5601	807	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	808	0		29	10	S5601_808_0	1		1	05/30/2014	2015.01	05/30/2014 09:11:02 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 4 Tier - Non Calendar (PDP)	10	29					S5601	808	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	809	0		29	10	S5601_809_0	1		1	05/30/2014	2015.01	05/30/2014 09:10:57 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 5 Tier - Calendar (PDP)	10	29					S5601	809	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	810	0		29	10	S5601_810_0	1		1	05/30/2014	2015.01	05/30/2014 09:10:51 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - 5 Tier - Non Calendar (PDP)	10	29					S5601	810	0	2015	National SilverScript Group		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5601	811	0		29	10	S5601_811_0	1		1	05/30/2014	2015.01	05/30/2014 09:10:45 AM Eastern Daylight Time					05/30/2014 09:12:07 AM Eastern Daylight Time	SILVERSCRIPT INSURANCE COMPANY	SilverScript	www.SilverScript.com	SilverScript Group - State of NY (PDP)	10	29					S5601	811	0	2015	National		1					2								www.SilverScript.com	www.SilverScript.com									(866)235-5660		(866)235-5660		(866)552-6106		(866)552-6106										(866)236-1069		(866)236-1069		(866)552-6288		(866)552-6288												
S5609	001	0		29	10	S5609_001_0	5		1	05/16/2014	2015.01	05/16/2014 12:10:27 PM Mountain Daylight Time		05/30/2014 08:34:03 AM Pacific Daylight Time			06/02/2014 04:50:01 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Basic (PDP)	10	29					S5609	001	0	2015	Region of Oregon and Washington		2					2								www.asuris.com/medicare	www.asuris.com/medicare									(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-												
S5609	002	0		29	10	S5609_002_0	5		1	05/16/2014	2015.01	05/16/2014 12:11:01 PM Mountain Daylight Time		05/30/2014 08:34:21 AM Pacific Daylight Time			06/02/2014 04:50:01 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script Enhanced (PDP)	10	29					S5609	002	0	2015	Region of Oregon and Washington		2					2								www.asuris.com/medicare	www.asuris.com/medicare									(800)541-8981		(800)541-8981		(888)369-3172		(888)369-3172										(711)-		(711)-		(711)-		(711)-												
S5609	802	0		29	10	S5609_802_0	5		1	05/08/2014	2015.01	05/08/2014 02:19:27 PM Mountain Daylight Time					06/02/2014 04:50:01 PM Pacific Daylight Time	ASURIS NORTHWEST HEALTH	Asuris Northwest Health	www.asuris.com/medicare	Asuris Medicare Script (PDP)	10	29					S5609	802	0	2015	Nationwide except territories		1					2								www.asuris.com/medicare	www.asuris.com/medicare									(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-												
S5617	003	0		29	10	S5617_003_0	4		1	07/16/2014	2015.02	07/16/2014 07:28:13 PM Eastern Daylight Time		07/09/2014 02:40:11 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	003	0	2015	New Hampshire and Maine		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	008	0		29	10	S5617_008_0	4		1	07/17/2014	2015.02	07/17/2014 07:30:05 PM Eastern Daylight Time		07/09/2014 02:40:49 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	008	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	013	0		29	10	S5617_013_0	4		1	07/17/2014	2015.02	07/17/2014 07:30:43 PM Eastern Daylight Time		07/09/2014 02:41:27 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	013	0	2015	New York		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	018	0		29	10	S5617_018_0	4		1	07/17/2014	2015.02	07/17/2014 07:31:25 PM Eastern Daylight Time		07/09/2014 02:42:14 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	018	0	2015	New Jersey		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	053	0		29	10	S5617_053_0	3		1	07/17/2014	2015.02	07/17/2014 07:31:55 PM Eastern Daylight Time		07/09/2014 02:42:51 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	053	0	2015	Florida		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	068	0		29	10	S5617_068_0	3		1	07/17/2014	2015.02	07/17/2014 07:32:29 PM Eastern Daylight Time		07/09/2014 02:43:28 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	068	0	2015	Ohio		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	088	0		29	10	S5617_088_0	3		1	07/17/2014	2015.02	07/17/2014 07:33:01 PM Eastern Daylight Time		07/09/2014 02:44:05 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	088	0	2015	Missouri		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	103	0		29	10	S5617_103_0	3		1	07/17/2014	2015.02	07/17/2014 07:33:30 PM Eastern Daylight Time		07/09/2014 02:44:43 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	103	0	2015	Louisiana		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	108	0		29	10	S5617_108_0	3		1	07/17/2014	2015.02	07/17/2014 07:33:58 PM Eastern Daylight Time		07/09/2014 02:45:21 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	108	0	2015	Texas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	113	0		29	10	S5617_113_0	3		1	07/17/2014	2015.02	07/17/2014 07:34:29 PM Eastern Daylight Time		07/09/2014 02:46:03 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	113	0	2015	Oklahoma		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	118	0		29	10	S5617_118_0	3		1	07/17/2014	2015.02	07/17/2014 07:34:53 PM Eastern Daylight Time		07/09/2014 02:46:44 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	118	0	2015	Kansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	123	0		29	10	S5617_123_0	3		1	07/17/2014	2015.02	07/17/2014 07:35:18 PM Eastern Daylight Time		07/09/2014 02:47:14 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	123	0	2015	IA, MN, MT, ND, NE, SD, WY		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	128	0		29	10	S5617_128_0	3		1	07/17/2014	2015.02	07/17/2014 07:35:46 PM Eastern Daylight Time		07/09/2014 02:47:49 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	128	0	2015	New Mexico		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	133	0		29	10	S5617_133_0	3		1	07/17/2014	2015.02	07/17/2014 07:36:16 PM Eastern Daylight Time		07/09/2014 02:48:41 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	133	0	2015	Colorado		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	138	0		29	10	S5617_138_0	3		1	07/17/2014	2015.02	07/17/2014 07:36:41 PM Eastern Daylight Time		07/09/2014 02:49:26 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	138	0	2015	Arizona		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	143	0		29	10	S5617_143_0	3		1	07/17/2014	2015.02	07/17/2014 07:37:09 PM Eastern Daylight Time		07/09/2014 02:50:03 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	143	0	2015	Nevada		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	148	0		29	10	S5617_148_0	3		1	07/17/2014	2015.02	07/17/2014 07:37:47 PM Eastern Daylight Time		07/09/2014 02:50:39 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	148	0	2015	Oregon and Washington		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	153	0		29	10	S5617_153_0	3		1	07/17/2014	2015.02	07/17/2014 07:38:13 PM Eastern Daylight Time		07/09/2014 02:51:16 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	153	0	2015	Idaho and Utah		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	158	0		29	10	S5617_158_0	3		1	07/17/2014	2015.02	07/17/2014 07:38:40 PM Eastern Daylight Time		07/09/2014 02:51:55 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	158	0	2015	California		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	163	0		29	10	S5617_163_0	3		1	07/17/2014	2015.02	07/17/2014 07:39:14 PM Eastern Daylight Time		07/09/2014 02:52:32 PM Central Daylight Time			07/18/2014 12:14:42 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	163	0	2015	Hawaii		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	172	0		29	10	S5617_172_0	3		1	07/17/2014	2015.02	07/17/2014 07:12:13 PM Eastern Daylight Time		07/10/2014 08:27:18 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	172	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	176	0		29	10	S5617_176_0	3		1	07/17/2014	2015.02	07/17/2014 07:12:48 PM Eastern Daylight Time		07/10/2014 08:27:28 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	176	0	2015	Pennsylvania and West Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	177	0		29	10	S5617_177_0	3		1	07/17/2014	2015.02	07/17/2014 07:13:23 PM Eastern Daylight Time		07/10/2014 08:27:39 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	177	0	2015	Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	178	0		29	10	S5617_178_0	3		1	07/17/2014	2015.02	07/17/2014 07:13:55 PM Eastern Daylight Time		07/10/2014 08:27:50 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	178	0	2015	North Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	179	0		29	10	S5617_179_0	3		1	07/17/2014	2015.02	07/17/2014 07:14:26 PM Eastern Daylight Time		07/10/2014 08:28:00 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	179	0	2015	South Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	181	0		29	10	S5617_181_0	3		1	07/17/2014	2015.02	07/17/2014 07:15:38 PM Eastern Daylight Time		07/10/2014 08:28:11 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	181	0	2015	Florida		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	182	0		29	10	S5617_182_0	3		1	07/17/2014	2015.02	07/17/2014 07:16:23 PM Eastern Daylight Time		07/10/2014 08:28:21 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	182	0	2015	Alabama and Tennessee		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	183	0		29	10	S5617_183_0	3		1	07/17/2014	2015.02	07/17/2014 07:17:02 PM Eastern Daylight Time		07/10/2014 08:28:32 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	183	0	2015	Michigan		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	184	0		29	10	S5617_184_0	3		1	07/17/2014	2015.02	07/17/2014 07:17:43 PM Eastern Daylight Time		07/10/2014 08:28:44 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	184	0	2015	Ohio		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	185	0		29	10	S5617_185_0	3		1	07/17/2014	2015.02	07/17/2014 07:18:20 PM Eastern Daylight Time		07/10/2014 08:28:58 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	185	0	2015	Indiana and Kentucky		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	187	0		29	10	S5617_187_0	3		1	07/17/2014	2015.02	07/17/2014 07:18:54 PM Eastern Daylight Time		07/10/2014 08:29:10 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	187	0	2015	Illinois		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	188	0		29	10	S5617_188_0	3		1	07/17/2014	2015.02	07/17/2014 07:19:59 PM Eastern Daylight Time		07/10/2014 08:29:21 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	188	0	2015	Missouri		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	189	0		29	10	S5617_189_0	3		1	07/17/2014	2015.02	07/17/2014 07:20:31 PM Eastern Daylight Time		07/10/2014 08:29:36 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	189	0	2015	Arkansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	192	0		29	10	S5617_192_0	3		1	07/17/2014	2015.02	07/17/2014 07:21:07 PM Eastern Daylight Time		07/10/2014 08:29:46 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	192	0	2015	Texas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	195	0		29	10	S5617_195_0	3		1	07/17/2014	2015.02	07/17/2014 07:21:45 PM Eastern Daylight Time		07/10/2014 08:29:57 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	195	0	2015	IA, MN, MT, ND, NE, SD, WY		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	198	0		29	10	S5617_198_0	3		1	07/17/2014	2015.02	07/17/2014 07:22:26 PM Eastern Daylight Time		07/10/2014 08:30:08 AM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	198	0	2015	Arizona		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	214	0		29	10	S5617_214_0	3		1	07/17/2014	2015.02	07/17/2014 07:39:51 PM Eastern Daylight Time		07/09/2014 02:52:59 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	214	0	2015	Delaware, Maryland and District of Columbia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	215	0		29	10	S5617_215_0	3		1	07/17/2014	2015.02	07/17/2014 07:40:15 PM Eastern Daylight Time		07/09/2014 02:53:30 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	215	0	2015	Pennsylvania and West Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	216	0		29	10	S5617_216_0	3		1	07/17/2014	2015.02	07/17/2014 07:40:41 PM Eastern Daylight Time		07/09/2014 02:53:57 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	216	0	2015	Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	217	0		29	10	S5617_217_0	3		1	07/17/2014	2015.02	07/17/2014 07:41:10 PM Eastern Daylight Time		07/09/2014 02:54:20 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	217	0	2015	North Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	218	0		29	10	S5617_218_0	3		1	07/17/2014	2015.02	07/17/2014 07:41:43 PM Eastern Daylight Time		07/09/2014 02:54:47 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	218	0	2015	South Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	219	0		29	10	S5617_219_0	3		1	07/17/2014	2015.02	07/17/2014 07:42:12 PM Eastern Daylight Time		07/09/2014 02:55:11 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	219	0	2015	Georgia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	220	0		29	10	S5617_220_0	3		1	07/17/2014	2015.02	07/17/2014 07:42:44 PM Eastern Daylight Time		07/09/2014 02:55:37 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	220	0	2015	Alabama and Tennessee		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	221	0		29	10	S5617_221_0	3		1	07/17/2014	2015.02	07/17/2014 07:43:17 PM Eastern Daylight Time		07/09/2014 02:56:00 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	221	0	2015	Michigan		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	222	0		29	10	S5617_222_0	3		1	07/17/2014	2015.02	07/17/2014 07:43:49 PM Eastern Daylight Time		07/09/2014 02:56:36 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	222	0	2015	Indiana and Kentucky		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	223	0		29	10	S5617_223_0	3		1	07/17/2014	2015.02	07/17/2014 07:44:17 PM Eastern Daylight Time		07/09/2014 02:57:04 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	223	0	2015	Wisconsin		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	224	0		29	10	S5617_224_0	3		1	07/17/2014	2015.02	07/17/2014 07:44:47 PM Eastern Daylight Time		07/09/2014 02:57:32 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	224	0	2015	Illinois		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	225	0		29	10	S5617_225_0	3		1	07/17/2014	2015.02	07/17/2014 07:45:15 PM Eastern Daylight Time		07/09/2014 02:58:00 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	225	0	2015	Arkansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	226	0		29	10	S5617_226_0	3		1	07/17/2014	2015.02	07/17/2014 07:45:44 PM Eastern Daylight Time		07/09/2014 02:58:29 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	226	0	2015	Mississippi		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	227	0		29	10	S5617_227_0	3		1	07/17/2014	2015.02	07/17/2014 07:46:30 PM Eastern Daylight Time		07/09/2014 02:59:05 PM Central Daylight Time			07/18/2014 12:43:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure (PDP)	10	29					S5617	227	0	2015	Alaska		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	228	0		29	10	S5617_228_0	3		1	07/17/2014	2015.02	07/17/2014 07:11:31 PM Eastern Daylight Time		07/10/2014 08:30:19 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	228	0	2015	New Hampshire and Maine		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	229	0		29	10	S5617_229_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:42 PM Eastern Daylight Time		07/10/2014 08:30:28 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	229	0	2015	New York		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	230	0		29	10	S5617_230_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:43 PM Eastern Daylight Time		07/10/2014 09:11:29 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	230	0	2015	New Jersey		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	231	0		29	10	S5617_231_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:43 PM Eastern Daylight Time		07/10/2014 08:57:42 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	231	0	2015	Delaware, Maryland and District of Columbia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	232	0		29	10	S5617_232_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:44 PM Eastern Daylight Time		07/10/2014 08:57:52 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	232	0	2015	Georgia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	233	0		29	10	S5617_233_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:44 PM Eastern Daylight Time		07/10/2014 08:58:03 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	233	0	2015	Wisconsin		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	234	0		29	10	S5617_234_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:44 PM Eastern Daylight Time		07/10/2014 08:58:14 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	234	0	2015	Mississippi		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	235	0		29	10	S5617_235_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:45 PM Eastern Daylight Time		07/10/2014 08:58:25 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	235	0	2015	Louisiana		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	236	0		29	10	S5617_236_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:45 PM Eastern Daylight Time		07/10/2014 08:58:36 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	236	0	2015	Oklahoma		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	237	0		29	10	S5617_237_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:45 PM Eastern Daylight Time		07/10/2014 08:58:47 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	237	0	2015	Kansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	238	0		29	10	S5617_238_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:46 PM Eastern Daylight Time		07/10/2014 08:58:59 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	238	0	2015	New Mexico		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	239	0		29	10	S5617_239_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:46 PM Eastern Daylight Time		07/10/2014 08:59:09 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	239	0	2015	Colorado		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	240	0		29	10	S5617_240_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:46 PM Eastern Daylight Time		07/10/2014 08:59:20 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	240	0	2015	Nevada		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	241	0		29	10	S5617_241_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:47 PM Eastern Daylight Time		07/10/2014 08:59:31 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	241	0	2015	Oregon and Washington		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	242	0		29	10	S5617_242_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:47 PM Eastern Daylight Time		07/10/2014 08:59:43 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	242	0	2015	Idaho and Utah		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	243	0		29	10	S5617_243_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:47 PM Eastern Daylight Time		07/10/2014 08:59:54 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	243	0	2015	California		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	244	0		29	10	S5617_244_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:48 PM Eastern Daylight Time		07/10/2014 09:00:04 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	244	0	2015	Hawaii		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	245	0		29	10	S5617_245_0	3		1	07/16/2014	2015.02	07/17/2014 02:11:48 PM Eastern Daylight Time		07/10/2014 09:00:16 AM Central Daylight Time			07/18/2014 01:00:21 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Max (PDP)	10	29					S5617	245	0	2015	Alaska		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	246	0		29	10	S5617_246_0	3		1	07/17/2014	2015.02	07/17/2014 06:23:14 PM Eastern Daylight Time		07/10/2014 09:45:14 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	246	0	2015	New Hampshire and Maine		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	247	0		29	10	S5617_247_0	3		1	07/16/2014	2015.02	07/17/2014 02:09:38 PM Eastern Daylight Time		07/10/2014 09:45:31 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	247	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	248	0		29	10	S5617_248_0	3		1	07/17/2014	2015.02	07/17/2014 06:25:20 PM Eastern Daylight Time		07/10/2014 09:45:48 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	248	0	2015	New York		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	249	0		29	10	S5617_249_0	3		1	07/16/2014	2015.02	07/17/2014 02:09:39 PM Eastern Daylight Time		07/10/2014 09:46:04 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	249	0	2015	New Jersey		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	250	0		29	10	S5617_250_0	3		1	07/16/2014	2015.02	07/17/2014 02:09:39 PM Eastern Daylight Time		07/10/2014 09:46:20 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	250	0	2015	Delaware, Maryland and District of Columbia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	251	0		29	10	S5617_251_0	3		1	07/16/2014	2015.02	07/17/2014 02:09:39 PM Eastern Daylight Time		07/10/2014 09:46:37 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	251	0	2015	Pennsylvania and West Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	252	0		29	10	S5617_252_0	3		1	07/17/2014	2015.02	07/17/2014 06:28:32 PM Eastern Daylight Time		07/10/2014 09:46:53 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	252	0	2015	Virginia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	253	0		29	10	S5617_253_0	3		1	07/17/2014	2015.02	07/17/2014 06:30:08 PM Eastern Daylight Time		07/10/2014 09:47:11 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	253	0	2015	North Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	254	0		29	10	S5617_254_0	3		1	07/17/2014	2015.02	07/17/2014 06:32:02 PM Eastern Daylight Time		07/10/2014 09:47:27 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	254	0	2015	South Carolina		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	255	0		29	10	S5617_255_0	3		1	07/17/2014	2015.02	07/17/2014 06:33:30 PM Eastern Daylight Time		07/10/2014 09:47:45 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	255	0	2015	Georgia		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	256	0		29	10	S5617_256_0	3		1	07/17/2014	2015.02	07/17/2014 06:34:47 PM Eastern Daylight Time		07/10/2014 09:48:03 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	256	0	2015	Florida		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	257	0		29	10	S5617_257_0	3		1	07/17/2014	2015.02	07/17/2014 06:36:17 PM Eastern Daylight Time		07/10/2014 09:48:20 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	257	0	2015	Alabama and Tennessee		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	258	0		29	10	S5617_258_0	3		1	07/17/2014	2015.02	07/17/2014 06:37:50 PM Eastern Daylight Time		07/10/2014 09:48:36 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	258	0	2015	Michigan		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	259	0		29	10	S5617_259_0	3		1	07/17/2014	2015.02	07/17/2014 06:39:19 PM Eastern Daylight Time		07/10/2014 09:48:52 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	259	0	2015	Ohio		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	260	0		29	10	S5617_260_0	3		1	07/17/2014	2015.02	07/17/2014 06:41:09 PM Eastern Daylight Time		07/10/2014 09:49:09 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	260	0	2015	Indiana and Kentucky		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	261	0		29	10	S5617_261_0	3		1	07/17/2014	2015.02	07/17/2014 06:44:46 PM Eastern Daylight Time		07/10/2014 09:49:32 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	261	0	2015	Wisconsin		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	262	0		29	10	S5617_262_0	3		1	07/17/2014	2015.02	07/17/2014 06:46:01 PM Eastern Daylight Time		07/10/2014 09:49:49 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	262	0	2015	Illinois		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	263	0		29	10	S5617_263_0	3		1	07/17/2014	2015.02	07/17/2014 06:47:28 PM Eastern Daylight Time		07/10/2014 09:50:05 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	263	0	2015	Missouri		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	264	0		29	10	S5617_264_0	3		1	07/17/2014	2015.02	07/17/2014 06:49:16 PM Eastern Daylight Time		07/10/2014 09:50:22 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	264	0	2015	Arkansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	265	0		29	10	S5617_265_0	3		1	07/17/2014	2015.02	07/17/2014 06:50:29 PM Eastern Daylight Time		07/10/2014 09:50:38 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	265	0	2015	Mississippi		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	266	0		29	10	S5617_266_0	3		1	07/17/2014	2015.02	07/17/2014 06:51:42 PM Eastern Daylight Time		07/10/2014 09:50:55 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	266	0	2015	Louisiana		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	267	0		29	10	S5617_267_0	3		1	07/17/2014	2015.02	07/17/2014 06:53:05 PM Eastern Daylight Time		07/10/2014 09:51:11 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	267	0	2015	Texas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	268	0		29	10	S5617_268_0	3		1	07/17/2014	2015.02	07/17/2014 06:54:29 PM Eastern Daylight Time		07/10/2014 09:51:27 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	268	0	2015	Oklahoma		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	269	0		29	10	S5617_269_0	3		1	07/17/2014	2015.02	07/17/2014 06:55:54 PM Eastern Daylight Time		07/10/2014 09:51:43 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	269	0	2015	Kansas		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	270	0		29	10	S5617_270_0	3		1	07/17/2014	2015.02	07/17/2014 06:57:03 PM Eastern Daylight Time		07/10/2014 09:52:00 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	270	0	2015	IA, MN, MT, ND, SD, NE, WY		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	271	0		29	10	S5617_271_0	3		1	07/17/2014	2015.02	07/17/2014 06:58:11 PM Eastern Daylight Time		07/10/2014 09:52:16 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	271	0	2015	New Mexico		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	272	0		29	10	S5617_272_0	3		1	07/17/2014	2015.02	07/17/2014 07:00:13 PM Eastern Daylight Time		07/10/2014 09:52:34 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	272	0	2015	Colorado		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	273	0		29	10	S5617_273_0	3		1	07/17/2014	2015.02	07/17/2014 07:01:29 PM Eastern Daylight Time		07/10/2014 09:52:50 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	273	0	2015	Arizona		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	274	0		29	10	S5617_274_0	3		1	07/17/2014	2015.02	07/17/2014 07:02:52 PM Eastern Daylight Time		07/10/2014 09:53:06 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	274	0	2015	Nevada		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	275	0		29	10	S5617_275_0	3		1	07/17/2014	2015.02	07/17/2014 07:03:56 PM Eastern Daylight Time		07/10/2014 09:53:23 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	275	0	2015	Oregon and Washington		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	276	0		29	10	S5617_276_0	3		1	07/17/2014	2015.02	07/17/2014 07:05:34 PM Eastern Daylight Time		07/10/2014 09:53:39 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	276	0	2015	Idaho and Utah		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	277	0		29	10	S5617_277_0	3		1	07/17/2014	2015.02	07/17/2014 07:06:53 PM Eastern Daylight Time		07/10/2014 09:53:56 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	277	0	2015	California		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	278	0		29	10	S5617_278_0	3		1	07/17/2014	2015.02	07/17/2014 07:08:05 PM Eastern Daylight Time		07/10/2014 09:54:12 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	278	0	2015	Hawaii		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	279	0		29	10	S5617_279_0	3		1	07/17/2014	2015.02	07/17/2014 07:09:20 PM Eastern Daylight Time		07/10/2014 09:54:28 AM Central Daylight Time			07/18/2014 01:21:57 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Cigna-HealthSpring Rx Secure-Xtra (PDP)	10	29					S5617	279	0	2015	Alaska		2					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)222-6700		(800)222-6700		(800)735-1459		(800)735-1459										(711)-		(711)-		(711)-		(711)-												
S5617	801	0		29	10	S5617_801_0	1		1	05/28/2014	2015.02	05/28/2014 09:58:11 AM Eastern Daylight Time					05/30/2014 01:46:33 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan CY (PDP)	10	29					S5617	801	0	2015	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-												
S5617	802	0		29	10	S5617_802_0	1		1	05/28/2014	2015.02	05/28/2014 09:58:14 AM Eastern Daylight Time					05/30/2014 01:46:33 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan NCY (PDP)	10	29					S5617	802	0	2015	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-												
S5617	805	0		29	10	S5617_805_0	1		1	05/28/2014	2015.02	05/28/2014 09:58:18 AM Eastern Daylight Time					05/30/2014 01:46:33 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan CY (PDP)	10	29					S5617	805	0	2015	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-												
S5617	806	0		29	10	S5617_806_0	1		1	05/28/2014	2015.02	05/28/2014 09:58:22 AM Eastern Daylight Time					05/30/2014 01:46:33 PM Central Daylight Time	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Cigna-HealthSpring Rx	www.cignahealthspring.com	Employer Plan NCY (PDP)	10	29					S5617	806	0	2015	Nationwide		1					2							www.cignahealthspring.com/PDPpharmacy	www.cignahealthspring.com/PDPformulary	www.cignahealthspring.com/PDPpharmacy									(800)558-9562		(800)558-9562		(800)558-9562		(800)558-9562										(711)-		(711)-		(711)-		(711)-												
S5660	104	0		29	10	S5660_104_0	3		1	05/31/2014	2015.01	05/31/2014 03:23:23 PM Eastern Daylight Time		07/17/2014 09:42:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	104	0	2015	Northern New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	105	0		29	10	S5660_105_0	2		1	05/31/2014	2015.01	05/31/2014 10:19:27 AM Eastern Daylight Time		07/17/2014 09:42:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	105	0	2015	Central New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	106	0		29	10	S5660_106_0	2		1	05/31/2014	2015.01	05/31/2014 10:21:03 AM Eastern Daylight Time		07/17/2014 09:41:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	106	0	2015	State of New Jersey		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	107	0		29	10	S5660_107_0	2		1	05/31/2014	2015.01	05/31/2014 10:21:46 AM Eastern Daylight Time		07/17/2014 09:41:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	107	0	2015	Mid-Atlantic		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	108	0		29	10	S5660_108_0	2		1	05/31/2014	2015.01	05/31/2014 10:23:00 AM Eastern Daylight Time		07/17/2014 09:40:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	108	0	2015	States of Pennsylvania and West Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	109	0		29	10	S5660_109_0	2		1	05/31/2014	2015.01	05/31/2014 10:23:46 AM Eastern Daylight Time		07/17/2014 09:39:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	109	0	2015	State of Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	110	0		29	10	S5660_110_0	2		1	05/31/2014	2015.01	05/31/2014 10:24:23 AM Eastern Daylight Time		07/17/2014 09:39:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	110	0	2015	State of North Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	111	0		29	10	S5660_111_0	2		1	05/31/2014	2015.01	05/31/2014 10:25:06 AM Eastern Daylight Time		07/17/2014 09:38:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	111	0	2015	State of South Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	112	0		29	10	S5660_112_0	2		1	05/31/2014	2015.01	05/31/2014 10:25:50 AM Eastern Daylight Time		07/17/2014 09:43:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	112	0	2015	State of Georgia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	113	0		29	10	S5660_113_0	2		1	05/31/2014	2015.01	05/31/2014 10:26:31 AM Eastern Daylight Time		07/17/2014 09:46:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	113	0	2015	State of Florida		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	114	0		29	10	S5660_114_0	2		1	05/31/2014	2015.01	05/31/2014 10:27:07 AM Eastern Daylight Time		07/17/2014 09:46:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	114	0	2015	States of Alabama and Tennessee		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	115	0		29	10	S5660_115_0	2		1	05/31/2014	2015.01	05/31/2014 10:27:47 AM Eastern Daylight Time		07/17/2014 09:45:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	115	0	2015	State of Michigan		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	116	0		29	10	S5660_116_0	2		1	05/31/2014	2015.01	05/31/2014 10:28:34 AM Eastern Daylight Time		07/17/2014 09:45:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	116	0	2015	State of Ohio		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	117	0		29	10	S5660_117_0	2		1	05/31/2014	2015.01	05/31/2014 10:29:11 AM Eastern Daylight Time		07/17/2014 09:44:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	117	0	2015	States of Indiana and Kentucky		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	118	0		29	10	S5660_118_0	2		1	05/31/2014	2015.01	05/31/2014 10:30:00 AM Eastern Daylight Time		07/17/2014 09:49:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	118	0	2015	State of Wisconsin		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	119	0		29	10	S5660_119_0	2		1	05/31/2014	2015.01	05/31/2014 10:30:49 AM Eastern Daylight Time		07/17/2014 09:49:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	119	0	2015	State of Illinois		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	120	0		29	10	S5660_120_0	2		1	05/31/2014	2015.01	05/31/2014 10:31:26 AM Eastern Daylight Time		07/17/2014 09:48:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	120	0	2015	State of Missouri		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	121	0		29	10	S5660_121_0	2		1	05/31/2014	2015.01	05/31/2014 10:32:07 AM Eastern Daylight Time		07/17/2014 09:48:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	121	0	2015	State of Arkansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	122	0		29	10	S5660_122_0	2		1	05/31/2014	2015.01	05/31/2014 10:32:55 AM Eastern Daylight Time		07/17/2014 09:47:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	122	0	2015	State of Mississippi		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	123	0		29	10	S5660_123_0	2		1	05/31/2014	2015.01	05/31/2014 10:33:45 AM Eastern Daylight Time		07/17/2014 09:53:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	123	0	2015	State of Louisiana		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	124	0		29	10	S5660_124_0	2		1	05/31/2014	2015.01	05/31/2014 10:34:20 AM Eastern Daylight Time		07/17/2014 09:52:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	124	0	2015	State of Texas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	125	0		29	10	S5660_125_0	2		1	05/31/2014	2015.01	05/31/2014 10:34:54 AM Eastern Daylight Time		07/17/2014 09:51:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	125	0	2015	State of Oklahoma		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	126	0		29	10	S5660_126_0	2		1	05/31/2014	2015.01	05/31/2014 10:35:26 AM Eastern Daylight Time		07/17/2014 09:51:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	126	0	2015	State of Kansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	127	0		29	10	S5660_127_0	2		1	05/31/2014	2015.01	05/31/2014 10:36:01 AM Eastern Daylight Time		07/17/2014 09:56:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	127	0	2015	Upper Midwest and Northern Plains		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	128	0		29	10	S5660_128_0	2		1	05/31/2014	2015.01	05/31/2014 10:36:43 AM Eastern Daylight Time		07/17/2014 09:56:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	128	0	2015	State of New Mexico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	129	0		29	10	S5660_129_0	2		1	05/31/2014	2015.01	05/31/2014 10:37:17 AM Eastern Daylight Time		07/17/2014 09:55:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	129	0	2015	State of Colorado		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	130	0		29	10	S5660_130_0	2		1	05/31/2014	2015.01	05/31/2014 10:37:55 AM Eastern Daylight Time		07/17/2014 09:55:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	130	0	2015	State of Arizona		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	131	0		29	10	S5660_131_0	2		1	05/31/2014	2015.01	05/31/2014 01:30:30 PM Eastern Daylight Time		07/17/2014 09:54:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	131	0	2015	State of Nevada		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	132	0		29	10	S5660_132_0	2		1	05/31/2014	2015.01	05/31/2014 10:39:06 AM Eastern Daylight Time		07/17/2014 09:53:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	132	0	2015	States of Oregon and Washington		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	133	0		29	10	S5660_133_0	2		1	05/31/2014	2015.01	05/31/2014 10:39:48 AM Eastern Daylight Time		07/17/2014 09:58:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	133	0	2015	States of Idaho and Utah		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	134	0		29	10	S5660_134_0	2		1	05/31/2014	2015.01	05/31/2014 10:40:49 AM Eastern Daylight Time		07/17/2014 09:57:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	134	0	2015	State of California		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	135	0		29	10	S5660_135_0	2		1	05/31/2014	2015.01	05/31/2014 10:41:35 AM Eastern Daylight Time		07/17/2014 10:00:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	135	0	2015	State of Hawaii		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	136	0		29	10	S5660_136_0	2		1	05/31/2014	2015.01	05/31/2014 10:42:16 AM Eastern Daylight Time		07/17/2014 09:59:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	136	0	2015	State of Alaska		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	137	0		29	10	S5660_137_0	2		1	05/31/2014	2015.01	05/31/2014 10:42:50 AM Eastern Daylight Time		07/17/2014 09:58:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5660	137	0	2015	Puerto Rico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	172	0		29	10	S5660_172_0	2		1	05/31/2014	2015.01	05/31/2014 02:17:01 PM Eastern Daylight Time		07/17/2014 09:48:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	172	0	2015	Northern New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	176	0		29	10	S5660_176_0	2		1	05/31/2014	2015.01	05/31/2014 12:58:34 PM Eastern Daylight Time		07/17/2014 09:49:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	176	0	2015	States of Pennsylvania and West Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	180	0		29	10	S5660_180_0	2		1	05/31/2014	2015.01	05/31/2014 12:59:43 PM Eastern Daylight Time		07/17/2014 09:50:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	180	0	2015	State of Georgia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	181	0		29	10	S5660_181_0	2		1	05/31/2014	2015.01	05/31/2014 01:00:15 PM Eastern Daylight Time		07/17/2014 09:50:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	181	0	2015	State of Florida		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	182	0		29	10	S5660_182_0	2		1	05/31/2014	2015.01	05/31/2014 01:00:53 PM Eastern Daylight Time		07/17/2014 09:51:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	182	0	2015	States of Alabama and Tennessee		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	183	0		29	10	S5660_183_0	2		1	05/31/2014	2015.01	05/31/2014 01:01:42 PM Eastern Daylight Time		07/17/2014 09:51:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	183	0	2015	State of Michigan		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	184	0		29	10	S5660_184_0	2		1	05/31/2014	2015.01	05/31/2014 01:02:49 PM Eastern Daylight Time		07/17/2014 09:52:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	184	0	2015	State of Ohio		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	185	0		29	10	S5660_185_0	2		1	05/31/2014	2015.01	05/31/2014 01:03:29 PM Eastern Daylight Time		07/17/2014 09:53:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	185	0	2015	States of Indiana and Kentucky		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	186	0		29	10	S5660_186_0	2		1	06/01/2014	2015.01	06/01/2014 07:47:09 AM Eastern Daylight Time		07/17/2014 09:53:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	186	0	2015	State of Wisconsin		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	187	0		29	10	S5660_187_0	2		1	05/31/2014	2015.01	05/31/2014 01:04:24 PM Eastern Daylight Time		07/17/2014 09:54:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	187	0	2015	State of Illinois		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	190	0		29	10	S5660_190_0	2		1	05/31/2014	2015.01	05/31/2014 01:04:58 PM Eastern Daylight Time		07/17/2014 09:55:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	190	0	2015	State of Mississippi		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	192	0		29	10	S5660_192_0	2		1	05/31/2014	2015.01	05/31/2014 01:05:47 PM Eastern Daylight Time		07/17/2014 09:57:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	192	0	2015	State of Texas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	194	0		29	10	S5660_194_0	2		1	05/31/2014	2015.01	05/31/2014 01:06:10 PM Eastern Daylight Time		07/17/2014 09:58:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	194	0	2015	State of Kansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	195	0		29	10	S5660_195_0	2		1	05/31/2014	2015.01	05/31/2014 01:06:35 PM Eastern Daylight Time		07/17/2014 10:05:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	195	0	2015	Upper Midwest and Northern Plains		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	196	0		29	10	S5660_196_0	2		1	05/31/2014	2015.01	05/31/2014 01:06:58 PM Eastern Daylight Time		07/17/2014 10:08:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	196	0	2015	State of New Mexico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	197	0		29	10	S5660_197_0	2		1	05/31/2014	2015.01	05/31/2014 01:07:25 PM Eastern Daylight Time		07/17/2014 10:13:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	197	0	2015	State of Colorado		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	198	0		29	10	S5660_198_0	2		1	05/31/2014	2015.01	05/31/2014 01:07:51 PM Eastern Daylight Time		07/17/2014 10:17:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	198	0	2015	State of Arizona		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	199	0		29	10	S5660_199_0	2		1	05/31/2014	2015.01	05/31/2014 01:08:15 PM Eastern Daylight Time		07/17/2014 10:19:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	199	0	2015	State of Nevada		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	202	0		29	10	S5660_202_0	2		1	05/31/2014	2015.01	05/31/2014 01:08:38 PM Eastern Daylight Time		07/17/2014 10:21:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	202	0	2015	State of California		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	203	0		29	10	S5660_203_0	2		1	05/31/2014	2015.01	05/31/2014 01:09:07 PM Eastern Daylight Time		07/17/2014 10:29:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	203	0	2015	State of Hawaii		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	204	0		29	10	S5660_204_0	2		1	05/31/2014	2015.01	05/31/2014 01:09:30 PM Eastern Daylight Time		07/17/2014 10:30:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	204	0	2015	State of Alaska		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	205	0		29	10	S5660_205_0	2		1	05/31/2014	2015.01	05/31/2014 01:09:58 PM Eastern Daylight Time		07/17/2014 10:31:00 AM Eastern Daylight Time			07/18/2014 02:54:49 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	205	0	2015	Puerto Rico		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	206	0		29	10	S5660_206_0	1		1	05/31/2014	2015.01	05/31/2014 01:10:21 PM Eastern Daylight Time		06/01/2014 05:13:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	206	0	2015	Central New England		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	207	0		29	10	S5660_207_0	1		1	05/31/2014	2015.01	05/31/2014 01:10:44 PM Eastern Daylight Time		06/01/2014 05:12:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	207	0	2015	State of New Jersey		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	208	0		29	10	S5660_208_0	1		1	05/31/2014	2015.01	05/31/2014 01:11:05 PM Eastern Daylight Time		06/01/2014 05:11:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	208	0	2015	Mid-Atlantic		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	209	0		29	10	S5660_209_0	1		1	05/31/2014	2015.01	05/31/2014 01:11:30 PM Eastern Daylight Time		06/01/2014 05:10:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	209	0	2015	State of North Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	210	0		29	10	S5660_210_0	1		1	05/31/2014	2015.01	05/31/2014 01:11:56 PM Eastern Daylight Time		06/01/2014 05:10:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	210	0	2015	State of South Carolina		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	211	0		29	10	S5660_211_0	1		1	05/31/2014	2015.01	05/31/2014 01:12:23 PM Eastern Daylight Time		06/01/2014 05:09:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	211	0	2015	State of Missouri		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	212	0		29	10	S5660_212_0	1		1	05/31/2014	2015.01	05/31/2014 01:12:52 PM Eastern Daylight Time		06/01/2014 05:08:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	212	0	2015	State of Arkansas		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	213	0		29	10	S5660_213_0	1		1	05/31/2014	2015.01	05/31/2014 01:13:13 PM Eastern Daylight Time		06/01/2014 05:07:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	213	0	2015	State of Louisiana		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	214	0		29	10	S5660_214_0	1		1	05/31/2014	2015.01	05/31/2014 01:13:40 PM Eastern Daylight Time		06/01/2014 05:06:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	214	0	2015	State of Oklahoma		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	215	0		29	10	S5660_215_0	1		1	05/31/2014	2015.01	05/31/2014 01:14:06 PM Eastern Daylight Time		06/01/2014 05:05:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	215	0	2015	States of Oregon and Washington		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	216	0		29	10	S5660_216_0	1		1	05/31/2014	2015.01	05/31/2014 01:14:30 PM Eastern Daylight Time		06/01/2014 05:04:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	216	0	2015	States of Idaho and Utah		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	217	0		29	10	S5660_217_0	1		1	05/31/2014	2015.01	05/31/2014 01:14:54 PM Eastern Daylight Time		06/01/2014 05:03:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5660	217	0	2015	State of Virginia		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	801	0		29	10	S5660_801_0	1		1	06/02/2014	2015.01	06/02/2014 12:47:34 AM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	801	0	2015	National - High Performance 4 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	802	0		29	10	S5660_802_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:09 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	802	0	2015	National - National 4 Tier Preferred		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	803	0		29	10	S5660_803_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:14 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	803	0	2015	National -  4 Tier  Transition		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	804	0		29	10	S5660_804_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:21 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	804	0	2015	National - High Performance 4 Tier - Non Cal Year		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	806	0		29	10	S5660_806_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:26 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	806	0	2015	National - URMBT 4 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	807	0		29	10	S5660_807_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:32 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	807	0	2015	National - 5 Tier National Preferred		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	809	0		29	10	S5660_809_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:38 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S5660	809	0	2015	National - 5 Tier EGWP Transition		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5660	810	0		29	10	S5660_810_0	1		1	05/21/2014	2015.01	05/21/2014 12:53:43 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	MEDCO CONTAINMENT LIFE INSURANCE COMPANY	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medciare (PDP)	10	29					S5660	810	0	2015	National - 3 Tier High Performance		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4574		(800)758-4574		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5674	811	0		29	10	S5674_811_0	1		1	05/31/2014	2015.01	05/31/2014 02:20:18 PM Eastern Daylight Time					06/01/2014 10:31:40 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Employer Group - CY (PDP)	10	29					S5674	811	0	2015	First Health Part D Employer Group - CY		1					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5674	812	0		29	10	S5674_812_0	1		1	05/31/2014	2015.01	05/31/2014 02:20:28 PM Eastern Daylight Time					06/01/2014 10:31:40 AM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Employer Group - NCY (PDP)	10	29					S5674	812	0	2015	First Health Part D Employer Group - NCY		1					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5715	001	0		29	10	S5715_001_0	7		1	06/02/2014	2015.01	06/02/2014 03:12:04 PM Central Daylight Time		05/31/2014 04:41:30 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	001	0	2015	State of Illinois		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	002	0		29	10	S5715_002_0	6		1	06/02/2014	2015.01	06/02/2014 03:57:53 PM Central Daylight Time		05/31/2014 04:42:40 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	002	0	2015	State of Illinois		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	003	0		29	10	S5715_003_0	6		1	06/02/2014	2015.01	06/02/2014 03:15:48 PM Central Daylight Time		05/31/2014 05:00:54 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	003	0	2015	State of New Mexico		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	004	0		29	10	S5715_004_0	6		1	06/02/2014	2015.01	06/02/2014 03:58:16 PM Central Daylight Time		05/31/2014 06:07:34 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	004	0	2015	State of New Mexico		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	005	0		29	10	S5715_005_0	6		1	06/02/2014	2015.01	06/02/2014 03:17:24 PM Central Daylight Time		05/31/2014 05:04:44 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	005	0	2015	State of Texas		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	006	0		29	10	S5715_006_0	6		1	06/02/2014	2015.01	06/02/2014 03:58:16 PM Central Daylight Time		05/31/2014 05:07:44 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	006	0	2015	State of Texas		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	010	0		29	10	S5715_010_0	6		1	06/02/2014	2015.01	06/02/2014 03:19:40 PM Central Daylight Time		05/31/2014 05:08:50 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Value (PDP)	10	29					S5715	010	0	2015	State of Oklahoma		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	011	0		29	10	S5715_011_0	6		1	06/02/2014	2015.01	06/02/2014 03:58:16 PM Central Daylight Time		05/31/2014 05:09:58 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Plus (PDP)	10	29					S5715	011	0	2015	State of Oklahoma		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	012	0		29	10	S5715_012_0	3		1	06/02/2014	2015.01	06/02/2014 03:42:38 PM Central Daylight Time		05/31/2014 09:39:20 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	012	0	2015	State of Illinois		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	013	0		29	10	S5715_013_0	4		1	06/02/2014	2015.01	06/02/2014 04:13:02 PM Central Daylight Time		07/15/2014 09:56:34 AM Central Daylight Time			07/18/2014 03:40:37 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	013	0	2015	State of New Mexico		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	014	0		29	10	S5715_014_0	3		1	06/02/2014	2015.01	06/02/2014 04:17:36 PM Central Daylight Time		06/01/2014 01:26:48 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	014	0	2015	State of Texas		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	015	0		29	10	S5715_015_0	3		1	06/02/2014	2015.01	06/02/2014 04:22:29 PM Central Daylight Time		06/01/2014 01:27:46 PM Central Daylight Time			06/02/2014 04:46:44 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx Basic (PDP)	10	29					S5715	015	0	2015	State of Oklahoma		2					2								www.mybluepartd.com	www.mybluepartd.com									(888)285-2249		(888)285-2249		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	801	0		29	10	S5715_801_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:00 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	801	0	2015	State of Illinois		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	802	0		29	10	S5715_802_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:15 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	802	0	2015	State of New Mexico		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	803	0		29	10	S5715_803_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:17 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	803	0	2015	State of Texas		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	807	0		29	10	S5715_807_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:29 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	807	0	2015	State of Oklahoma		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	809	0		29	10	S5715_809_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:35 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	809	0	2015	State of Oklahoma		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	811	0		29	10	S5715_811_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:41 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	811	0	2015	State of Illinois		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	813	0		29	10	S5715_813_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:48 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	813	0	2015	State of New Mexico		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5715	815	0		29	10	S5715_815_0	1		1	04/14/2014	2015.01	04/14/2014 04:13:55 PM Central Daylight Time					06/01/2014 03:13:40 PM Central Daylight Time	HCSC INSURANCE SERVICES COMPANY	HISC - Blue Cross Blue Shield of IL, NM, OK, TX	www.mybluepartd.com	Blue Cross MedicareRx (PDP)	10	29					S5715	815	0	2015	State of Texas		1					2								www.mybluepartd.com	www.mybluepartd.com									(877)838-3833		(877)838-3833		(877)213-1817		(877)213-1817										(711)-		(711)-		(711)-		(711)-												
S5726	013	0		29	10	S5726_013_0	4		1	06/24/2014	2015.01	06/24/2014 07:08:13 PM Eastern Daylight Time		06/24/2014 02:48:59 PM Eastern Daylight Time			06/24/2014 07:11:13 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.partdkansas.com/shop	Blue MedicareRx Value (PDP)	10	29					S5726	013	0	2015	Kansas		2					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-												
S5726	014	0		29	10	S5726_014_0	4		1	06/24/2014	2015.01	06/24/2014 07:08:27 PM Eastern Daylight Time		07/09/2014 05:55:11 PM Eastern Daylight Time			07/14/2014 05:32:31 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.partdkansas.com/shop	Blue MedicareRx Plus (PDP)	10	29					S5726	014	0	2015	Kansas		2					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-												
S5726	015	0		29	10	S5726_015_0	3		1	06/24/2014	2015.01	06/24/2014 07:08:36 PM Eastern Daylight Time		06/24/2014 02:49:11 PM Eastern Daylight Time			06/24/2014 07:11:13 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.partdkansas.com/shop	Blue MedicareRx Premier (PDP)	10	29					S5726	015	0	2015	Kansas		2					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)755-2776		(866)755-2776		(877)471-4121		(877)471-4121										(711)-		(711)-		(711)-		(711)-												
S5726	805	0		29	10	S5726_805_0	3		1	05/29/2014	2015.01	05/29/2014 09:27:05 AM Eastern Daylight Time					05/30/2014 03:31:06 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF KANSAS	Blue MedicareRx	www.PartDKansas.com/shop	Blue MedicareRx (PDP)	10	29					S5726	805	0	2015	Kansas		1					2								www.PartDKansas.com/shop	www.PartDKansas.com/shop									(866)830-0174		(866)830-0174		(866)830-0296		(866)830-0296										(711)-		(711)-		(711)-		(711)-												
S5743	001	0		29	10	S5743_001_0	8		1	05/30/2014	2015.01	05/30/2014 01:28:36 PM Central Daylight Time		05/30/2014 01:59:18 PM Central Daylight Time			06/01/2014 10:14:06 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	MedicareBlue Rx Standard (PDP)	10	29					S5743	001	0	2015	States of IA, MN, MT, NE, ND, SD, WY		2					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-												
S5743	004	0		29	10	S5743_004_0	7		1	07/09/2014	2015.01	07/09/2014 10:44:51 AM Central Daylight Time		07/07/2014 09:18:44 PM Central Daylight Time			07/09/2014 12:42:56 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	MedicareBlue Rx Premier (PDP)	10	29					S5743	004	0	2015	States of IA, MN, MT, NE, ND, SD, WY		2					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-												
S5743	007	0		29	10	S5743_007_0	4		1	05/30/2014	2015.01	05/30/2014 01:30:28 PM Central Daylight Time		05/30/2014 01:52:22 PM Central Daylight Time			06/01/2014 10:14:06 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	MedicareBlue Rx Value Plus (PDP)	10	29					S5743	007	0	2015	States of IA, MN, MT, NE, ND, SD, WY		2					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(888)832-0075		(888)832-0075		(866)434-2037		(866)434-2037										(711)-		(711)-		(711)-		(711)-												
S5743	802	0		29	10	S5743_802_0	1		1	05/28/2014	2015.01	05/28/2014 12:56:47 PM Central Daylight Time					05/30/2014 01:08:55 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	Group MedicareBlue Rx (PDP)	10	29					S5743	802	0	2015	Nationwide		1					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(877)838-3827		(877)838-3827		(866)456-2885		(866)456-2885										(711)-		(711)-		(711)-		(711)-												
S5743	805	0		29	10	S5743_805_0	1		1	05/28/2014	2015.01	05/28/2014 12:57:08 PM Central Daylight Time					05/30/2014 01:08:55 PM Central Daylight Time	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	MedicareBlue Rx	www.YourMedicareSolutions.com	Group MedicareBlue Rx Self-funded (PDP) (PDP)	10	29					S5743	805	0	2015	Nationwide		1					2								www.YourMedicareSolutions.com	www.YourMedicareSolutions.com									(877)838-3827		(877)838-3827		(866)456-2885		(866)456-2885										(711)-		(711)-		(711)-		(711)-												
S5753	006	0		29	10	S5753_006_0	1		1	05/30/2014	2015.01	05/30/2014 01:53:03 PM Central Daylight Time		05/30/2014 03:03:32 PM Central Daylight Time			05/30/2014 03:35:54 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 1 (PDP)	10	29					S5753	006	0	2015	State of Wisconsin		2					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5753	007	0		29	10	S5753_007_0	1		1	05/30/2014	2015.01	05/30/2014 01:53:14 PM Central Daylight Time		05/30/2014 03:04:19 PM Central Daylight Time			05/30/2014 03:35:54 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS MedicareRx Plan 2 (PDP)	10	29					S5753	007	0	2015	State of Wisconsin		2					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5753	801	0		29	10	S5753_801_0	1		1	05/19/2014	2015.01	05/19/2014 10:43:53 AM Central Daylight Time					05/30/2014 03:35:54 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS Employer Plan - Calendar Year (PDP)	10	29					S5753	801	0	2015	National		1					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5753	803	0		29	10	S5753_803_0	1		1	05/19/2014	2015.01	05/19/2014 10:44:11 AM Central Daylight Time					05/30/2014 03:35:54 PM Central Daylight Time	WISCONSIN PHYSICIANS SERVICE INSURANCE CORPORATION	WPS Health Insurance	www.wpsmedicaredrugs.com	WPS Employer Plan Non-Calendar Year (PDP)	10	29					S5753	803	0	2015	National		1					2								www.wpsmedicaredrugs.com	www.wpsmedicaredrugs.com									(800)688-1604		(800)688-1604		(800)731-0459		(800)731-0459										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5755	006	0		29	10	S5755_006_0	5		1	07/18/2014	2015.01	07/18/2014 01:51:34 PM Central Daylight Time		07/21/2014 11:14:00 AM Central Daylight Time			07/22/2014 08:18:41 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	006	0	2015	States of CT, MA, RI and VT		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	007	0		29	10	S5755_007_0	4		1	06/30/2014	2015.01	06/30/2014 03:36:55 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	007	0	2015	State of New Jersey		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	008	0		29	10	S5755_008_0	4		1	06/30/2014	2015.01	06/30/2014 03:42:31 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	008	0	2015	States of Delaware and Maryland plus DC		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	009	0		29	10	S5755_009_0	4		1	06/30/2014	2015.01	06/30/2014 03:51:08 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	009	0	2015	States of Pennsylvania and West Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	010	0		29	10	S5755_010_0	4		1	06/30/2014	2015.01	06/30/2014 03:54:18 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	010	0	2015	State of Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	011	0		29	10	S5755_011_0	4		1	06/30/2014	2015.01	06/30/2014 03:57:15 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	011	0	2015	State of North Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	012	0		29	10	S5755_012_0	5		1	06/30/2014	2015.01	06/30/2014 04:03:53 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	012	0	2015	State of South Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	013	0		29	10	S5755_013_0	4		1	06/30/2014	2015.01	06/30/2014 04:07:26 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	013	0	2015	State of Georgia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	014	0		29	10	S5755_014_0	4		1	06/30/2014	2015.01	06/30/2014 04:09:39 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	014	0	2015	State of Florida		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	015	0		29	10	S5755_015_0	5		1	07/18/2014	2015.01	07/18/2014 01:53:06 PM Central Daylight Time		07/21/2014 11:14:00 AM Central Daylight Time			07/22/2014 08:18:41 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	015	0	2015	States of Alabama and Tennessee		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	016	0		29	10	S5755_016_0	4		1	06/30/2014	2015.01	06/30/2014 04:16:24 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	016	0	2015	State of Michigan		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	017	0		29	10	S5755_017_0	4		1	06/30/2014	2015.01	06/30/2014 04:18:55 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	017	0	2015	State of Ohio		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	018	0		29	10	S5755_018_0	4		1	06/30/2014	2015.01	06/30/2014 04:21:33 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	018	0	2015	States of Indiana and Kentucky		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	020	0		29	10	S5755_020_0	5		1	07/18/2014	2015.01	07/18/2014 01:57:45 PM Central Daylight Time		07/21/2014 11:14:00 AM Central Daylight Time			07/22/2014 08:18:41 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	020	0	2015	State of Illinois		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	021	0		29	10	S5755_021_0	4		1	06/30/2014	2015.01	06/30/2014 04:26:05 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	021	0	2015	State of Missouri		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	022	0		29	10	S5755_022_0	3		1	05/30/2014	2015.01	05/30/2014 10:30:43 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	022	0	2015	State of Arkansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	023	0		29	10	S5755_023_0	5		1	07/18/2014	2015.01	07/18/2014 01:59:56 PM Central Daylight Time		07/21/2014 11:14:00 AM Central Daylight Time			07/22/2014 08:18:41 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	023	0	2015	State of Mississippi		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	024	0		29	10	S5755_024_0	4		1	06/30/2014	2015.01	06/30/2014 04:33:20 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	024	0	2015	State of Louisiana		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	025	0		29	10	S5755_025_0	4		1	06/30/2014	2015.01	06/30/2014 04:36:25 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	025	0	2015	State of Texas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	026	0		29	10	S5755_026_0	4		1	06/30/2014	2015.01	06/30/2014 04:40:04 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	026	0	2015	State of Oklahoma		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	028	0		29	10	S5755_028_0	4		1	06/30/2014	2015.01	06/30/2014 04:42:32 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	028	0	2015	States of IA, MN, MT, NE, ND, SD and WY		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	029	0		29	10	S5755_029_0	4		1	06/30/2014	2015.01	06/30/2014 04:45:08 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	029	0	2015	State of New Mexico		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	030	0		29	10	S5755_030_0	3		1	05/30/2014	2015.01	05/30/2014 11:24:04 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	030	0	2015	State of Colorado		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	031	0		29	10	S5755_031_0	4		1	06/30/2014	2015.01	06/30/2014 04:47:34 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	031	0	2015	State of Arizona		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	032	0		29	10	S5755_032_0	5		1	07/18/2014	2015.01	07/18/2014 02:01:10 PM Central Daylight Time		07/21/2014 11:14:00 AM Central Daylight Time			07/22/2014 08:18:41 AM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	032	0	2015	State of Nevada		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	033	0		29	10	S5755_033_0	3		1	05/30/2014	2015.01	05/30/2014 11:25:39 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	033	0	2015	States of Oregon and Washington		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	034	0		29	10	S5755_034_0	3		1	05/30/2014	2015.01	05/30/2014 11:26:05 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	034	0	2015	States of Idaho and Utah		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	035	0		29	10	S5755_035_0	4		1	06/30/2014	2015.01	06/30/2014 04:51:55 PM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	035	0	2015	State of California		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	038	0		29	10	S5755_038_0	3		1	05/30/2014	2015.01	05/30/2014 11:04:16 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	038	0	2015	State of Hawaii		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	039	0		29	10	S5755_039_0	3		1	05/30/2014	2015.01	05/30/2014 11:05:17 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	039	0	2015	State of Alaska		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	073	0		29	10	S5755_073_0	3		1	05/30/2014	2015.01	05/30/2014 09:07:07 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	073	0	2015	States of Maine and New Hampshire		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	074	0		29	10	S5755_074_0	3		1	05/30/2014	2015.01	05/30/2014 09:07:33 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	074	0	2015	States of CT, MA, RI, and VT		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	075	0		29	10	S5755_075_0	3		1	05/30/2014	2015.01	05/30/2014 09:06:20 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	075	0	2015	State of New Jersey		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	076	0		29	10	S5755_076_0	3		1	05/30/2014	2015.01	05/30/2014 09:12:36 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	076	0	2015	States of Delaware, Maryland and DC		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	077	0		29	10	S5755_077_0	3		1	05/30/2014	2015.01	05/30/2014 09:14:07 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	077	0	2015	States of Pennsylvania and West Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	078	0		29	10	S5755_078_0	3		1	05/30/2014	2015.01	05/30/2014 09:15:00 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	078	0	2015	State of Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	079	0		29	10	S5755_079_0	3		1	05/30/2014	2015.01	05/30/2014 09:16:39 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	079	0	2015	State of North Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	080	0		29	10	S5755_080_0	4		1	05/30/2014	2015.01	05/30/2014 09:17:14 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	080	0	2015	State of South Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	081	0		29	10	S5755_081_0	3		1	05/30/2014	2015.01	05/30/2014 09:18:07 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	081	0	2015	State of Georgia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	082	0		29	10	S5755_082_0	3		1	05/30/2014	2015.01	05/30/2014 09:18:56 AM Central Daylight Time		07/18/2014 12:59:21 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	082	0	2015	State of Florida		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	083	0		29	10	S5755_083_0	3		1	05/30/2014	2015.01	05/30/2014 09:19:48 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	083	0	2015	States of Alabama and Tennessee		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	084	0		29	10	S5755_084_0	3		1	05/30/2014	2015.01	05/30/2014 09:20:27 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	084	0	2015	State of Michigan		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	085	0		29	10	S5755_085_0	3		1	05/30/2014	2015.01	05/30/2014 09:22:11 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	085	0	2015	State of Ohio		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	086	0		29	10	S5755_086_0	3		1	05/30/2014	2015.01	05/30/2014 09:26:01 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	086	0	2015	States of Indiana and Kentucky		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	087	0		29	10	S5755_087_0	3		1	05/30/2014	2015.01	05/30/2014 09:28:31 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	087	0	2015	State of Wisconsin		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	088	0		29	10	S5755_088_0	3		1	05/30/2014	2015.01	05/30/2014 10:22:07 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	088	0	2015	State of Illinois		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	089	0		29	10	S5755_089_0	3		1	05/30/2014	2015.01	05/30/2014 10:23:36 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	089	0	2015	State of Missouri		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	091	0		29	10	S5755_091_0	3		1	05/30/2014	2015.01	05/30/2014 10:32:04 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	091	0	2015	State of Mississippi		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	092	0		29	10	S5755_092_0	3		1	05/30/2014	2015.01	05/30/2014 10:32:53 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	092	0	2015	State of Louisiana		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	093	0		29	10	S5755_093_0	3		1	05/30/2014	2015.01	05/30/2014 10:35:44 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	093	0	2015	State of Texas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	094	0		29	10	S5755_094_0	3		1	05/30/2014	2015.01	05/30/2014 10:37:01 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	094	0	2015	State of Oklahoma		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	095	0		29	10	S5755_095_0	3		1	05/30/2014	2015.01	05/30/2014 10:37:53 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	095	0	2015	State of Kansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	096	0		29	10	S5755_096_0	3		1	05/30/2014	2015.01	05/30/2014 10:38:47 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	096	0	2015	States of IA, MN, MT, NE, ND, SD, and WY		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	097	0		29	10	S5755_097_0	3		1	05/30/2014	2015.01	05/30/2014 10:46:58 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	097	0	2015	State of New Mexico		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	098	0		29	10	S5755_098_0	3		1	05/30/2014	2015.01	05/30/2014 10:48:13 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	098	0	2015	State of Colorado		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	099	0		29	10	S5755_099_0	3		1	05/30/2014	2015.01	05/30/2014 10:49:01 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	099	0	2015	State of Arizona		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	100	0		29	10	S5755_100_0	3		1	05/30/2014	2015.01	05/30/2014 10:49:46 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	100	0	2015	State of Nevada		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	101	0		29	10	S5755_101_0	3		1	05/30/2014	2015.01	05/30/2014 10:50:29 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	101	0	2015	States of Oregon and Washington		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	102	0		29	10	S5755_102_0	3		1	05/30/2014	2015.01	05/30/2014 10:51:59 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	102	0	2015	States of Idaho and Utah		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	103	0		29	10	S5755_103_0	3		1	05/30/2014	2015.01	05/30/2014 10:53:25 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Select (PDP)	10	29					S5755	103	0	2015	State of California		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	106	0		29	10	S5755_106_0	3		1	05/30/2014	2015.01	05/30/2014 11:19:47 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Enhanced (PDP)	10	29					S5755	106	0	2015	State of Arkansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	107	0		29	10	S5755_107_0	4		1	06/30/2014	2015.01	06/30/2014 02:14:49 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	107	0	2015	States of Maine and New Hampshire		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	108	0		29	10	S5755_108_0	4		1	06/30/2014	2015.01	06/30/2014 02:16:21 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	108	0	2015	States of CT, MA, RI, and VT		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	109	0		29	10	S5755_109_0	4		1	06/30/2014	2015.01	06/30/2014 02:18:08 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	109	0	2015	State of New Jersey		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	110	0		29	10	S5755_110_0	4		1	06/30/2014	2015.01	06/30/2014 02:19:31 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	110	0	2015	States of Delaware, Maryland and DC		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	111	0		29	10	S5755_111_0	4		1	06/30/2014	2015.01	06/30/2014 02:21:28 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	111	0	2015	States of Pennsylvania and West Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	112	0		29	10	S5755_112_0	4		1	06/30/2014	2015.01	06/30/2014 02:22:44 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	112	0	2015	State of Virginia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	113	0		29	10	S5755_113_0	4		1	06/30/2014	2015.01	06/30/2014 02:24:37 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	113	0	2015	State of North Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	114	0		29	10	S5755_114_0	5		1	06/30/2014	2015.01	06/30/2014 02:26:27 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	114	0	2015	State of South Carolina		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	115	0		29	10	S5755_115_0	4		1	06/30/2014	2015.01	06/30/2014 02:28:53 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	115	0	2015	State of Georgia		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	116	0		29	10	S5755_116_0	3		1	05/31/2014	2015.01	05/31/2014 09:03:39 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	116	0	2015	State of Florida		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	117	0		29	10	S5755_117_0	4		1	06/30/2014	2015.01	06/30/2014 02:32:24 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	117	0	2015	States of Alabama and Tennessee		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	118	0		29	10	S5755_118_0	4		1	06/30/2014	2015.01	06/30/2014 02:34:21 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	118	0	2015	State of Michigan		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	119	0		29	10	S5755_119_0	4		1	06/30/2014	2015.01	06/30/2014 02:35:31 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	119	0	2015	State of Ohio		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	120	0		29	10	S5755_120_0	4		1	06/30/2014	2015.01	06/30/2014 02:37:25 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	120	0	2015	States of Indiana and Kentucky		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	121	0		29	10	S5755_121_0	4		1	06/30/2014	2015.01	06/30/2014 02:38:46 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	121	0	2015	State of Wisconsin		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	122	0		29	10	S5755_122_0	4		1	06/30/2014	2015.01	06/30/2014 02:39:46 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	122	0	2015	State of Illinois		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	123	0		29	10	S5755_123_0	3		1	05/31/2014	2015.01	05/31/2014 09:20:22 AM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	123	0	2015	State of Missouri		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	124	0		29	10	S5755_124_0	4		1	06/30/2014	2015.01	06/30/2014 02:41:10 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	124	0	2015	State of Mississippi		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	125	0		29	10	S5755_125_0	4		1	06/30/2014	2015.01	06/30/2014 02:45:07 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	125	0	2015	State of Louisiana		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	126	0		29	10	S5755_126_0	4		1	06/30/2014	2015.01	06/30/2014 02:48:15 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	126	0	2015	State of Texas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	127	0		29	10	S5755_127_0	4		1	06/30/2014	2015.01	06/30/2014 02:49:21 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	127	0	2015	State of Oklahoma		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	128	0		29	10	S5755_128_0	4		1	06/30/2014	2015.01	06/30/2014 02:50:46 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	128	0	2015	State of Kansas		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	129	0		29	10	S5755_129_0	4		1	06/30/2014	2015.01	06/30/2014 02:52:19 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	129	0	2015	States of IA, MN, MT, NE, ND, SD, and WY		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	130	0		29	10	S5755_130_0	4		1	06/30/2014	2015.01	06/30/2014 02:53:29 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	130	0	2015	State of New Mexico		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	131	0		29	10	S5755_131_0	4		1	06/30/2014	2015.01	06/30/2014 02:54:28 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	131	0	2015	State of Arizona		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	132	0		29	10	S5755_132_0	4		1	06/30/2014	2015.01	06/30/2014 03:08:34 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	132	0	2015	State of Nevada		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	133	0		29	10	S5755_133_0	4		1	06/30/2014	2015.01	06/30/2014 03:09:37 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	133	0	2015	State of California		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	134	0		29	10	S5755_134_0	4		1	06/30/2014	2015.01	06/30/2014 03:10:41 PM Central Daylight Time		07/18/2014 12:59:22 PM Central Daylight Time			07/18/2014 01:11:10 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American - Essential (PDP)	10	29					S5755	134	0	2015	State of Hawaii		2					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4169		(866)524-4169		(877)723-1662		(877)723-1662										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	801	0		29	10	S5755_801_0	3		1	06/02/2014	2015.01	06/02/2014 01:37:07 PM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American Employer Calendar Plan (PDP)	10	29					S5755	801	0	2015	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	802	0		29	10	S5755_802_0	3		1	06/02/2014	2015.01	06/02/2014 01:37:27 PM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	United American Employer Non-Cal Drug Plan (PDP)	10	29					S5755	802	0	2015	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	805	0		29	10	S5755_805_0	3		1	06/02/2014	2015.01	06/02/2014 01:37:42 PM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	UA EGWP- Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5755	805	0	2015	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5755	806	0		29	10	S5755_806_0	3		1	06/02/2014	2015.01	06/02/2014 01:37:55 PM Central Daylight Time					06/02/2014 05:18:01 PM Central Daylight Time	UNITED AMERICAN INSURANCE COMPANY	United American Insurance Company	www.uamedicarepartd.com	UA EGWP- Non-Calendar Plan 2nd Formulary Opt. (PDP)	10	29					S5755	806	0	2015	National		1					2								http://www.uamedicarepartd.com/en/Our-Plans/Formulary.aspx	http://www.uamedicarepartd.com/Our-Plans/Pharmacies.aspx									(866)524-4199		(866)524-4199		(866)524-4199		(866)524-4199										(866)524-4170		(866)524-4170		(866)524-4170		(866)524-4170												
S5768	125	0		29	10	S5768_125_0	2		1	05/25/2014	2015.01	05/25/2014 04:25:42 PM Eastern Daylight Time		05/30/2014 05:36:47 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	125	0	2015	First Health Part D Value Plus - ME_NH		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	126	0		29	10	S5768_126_0	2		1	05/25/2014	2015.01	05/25/2014 04:30:26 PM Eastern Daylight Time		05/30/2014 05:36:55 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	126	0	2015	First Health Part D Value Plus - Central New Engla		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	127	0		29	10	S5768_127_0	2		1	05/25/2014	2015.01	05/25/2014 04:32:35 PM Eastern Daylight Time		05/30/2014 05:37:03 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	127	0	2015	First Health Part D Value Plus - NJ		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	128	0		29	10	S5768_128_0	2		1	05/25/2014	2015.01	05/25/2014 04:33:32 PM Eastern Daylight Time		05/30/2014 05:37:12 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	128	0	2015	First Health Part D Value Plus - Mid Atlantic		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	129	0		29	10	S5768_129_0	2		1	05/25/2014	2015.01	05/25/2014 04:34:23 PM Eastern Daylight Time		05/30/2014 05:37:19 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	129	0	2015	First Health Part D Value Plus - PA_WV		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	130	0		29	10	S5768_130_0	2		1	05/25/2014	2015.01	05/25/2014 04:35:23 PM Eastern Daylight Time		05/30/2014 05:37:28 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	130	0	2015	First Health Part D Value Plus - Virginia		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	131	0		29	10	S5768_131_0	2		1	05/25/2014	2015.01	05/25/2014 04:36:11 PM Eastern Daylight Time		05/30/2014 05:37:36 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	131	0	2015	First Health Part D Value Plus - North Carolina		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	132	0		29	10	S5768_132_0	2		1	05/25/2014	2015.01	05/25/2014 04:37:30 PM Eastern Daylight Time		05/30/2014 05:37:45 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	132	0	2015	First Health Part D Value Plus - South Carolina		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	133	0		29	10	S5768_133_0	1		1	05/25/2014	2015.01	05/25/2014 04:45:47 PM Eastern Daylight Time		05/30/2014 05:37:53 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	133	0	2015	First Health Part D Value Plus - Georgia		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	134	0		29	10	S5768_134_0	1		1	05/25/2014	2015.01	05/25/2014 04:47:21 PM Eastern Daylight Time		05/30/2014 05:38:01 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	134	0	2015	First Health Part D Value Plus - Florida		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	135	0		29	10	S5768_135_0	1		1	05/25/2014	2015.01	05/25/2014 04:48:59 PM Eastern Daylight Time		05/30/2014 05:38:09 PM Eastern Daylight Time			05/31/2014 01:20:13 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	135	0	2015	First Health Part D Value Plus - AL_TN		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	136	0		29	10	S5768_136_0	1		1	05/25/2014	2015.01	05/25/2014 04:49:48 PM Eastern Daylight Time		05/30/2014 05:38:18 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	136	0	2015	First Health Part D Value Plus - Michigan		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	137	0		29	10	S5768_137_0	1		1	05/25/2014	2015.01	05/25/2014 05:22:10 PM Eastern Daylight Time		05/30/2014 05:38:26 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	137	0	2015	First Health Part D Value Plus - Ohio		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	138	0		29	10	S5768_138_0	1		1	05/25/2014	2015.01	05/25/2014 04:50:54 PM Eastern Daylight Time		05/30/2014 05:38:34 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	138	0	2015	First Health Part D Value Plus - IN_KY		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	139	0		29	10	S5768_139_0	1		1	05/25/2014	2015.01	05/25/2014 04:51:45 PM Eastern Daylight Time		05/30/2014 05:38:42 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	139	0	2015	First Health Part D Value Plus - Wisconsin		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	140	0		29	10	S5768_140_0	1		1	05/25/2014	2015.01	05/25/2014 04:53:30 PM Eastern Daylight Time		05/30/2014 05:38:51 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	140	0	2015	First Health Part D Value Plus - Illinois		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	141	0		29	10	S5768_141_0	1		1	05/25/2014	2015.01	05/25/2014 04:54:22 PM Eastern Daylight Time		05/30/2014 05:38:59 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	141	0	2015	First Health Part D Value Plus - Missouri		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	142	0		29	10	S5768_142_0	1		1	05/25/2014	2015.01	05/25/2014 04:55:15 PM Eastern Daylight Time		05/30/2014 05:39:07 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	142	0	2015	First Health Part D Value Plus - Arkansas		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	143	0		29	10	S5768_143_0	1		1	05/25/2014	2015.01	05/25/2014 04:56:08 PM Eastern Daylight Time		05/30/2014 05:39:16 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	143	0	2015	First Health Part D Value Plus - Mississippi		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	144	0		29	10	S5768_144_0	1		1	05/25/2014	2015.01	05/25/2014 04:57:10 PM Eastern Daylight Time		05/30/2014 05:39:24 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	144	0	2015	First Health Part D Value Plus - Louisiana		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	145	0		29	10	S5768_145_0	1		1	05/25/2014	2015.01	05/25/2014 05:12:08 PM Eastern Daylight Time		05/30/2014 05:39:33 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	http://www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	145	0	2015	First Health Part D Value Plus - Texas		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	146	0		29	10	S5768_146_0	1		1	05/25/2014	2015.01	05/25/2014 05:12:53 PM Eastern Daylight Time		05/30/2014 05:39:41 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	146	0	2015	First Health Part D Value Plus - Oklahoma		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	147	0		29	10	S5768_147_0	1		1	05/25/2014	2015.01	05/25/2014 05:13:40 PM Eastern Daylight Time		05/30/2014 05:39:48 PM Eastern Daylight Time			05/31/2014 01:27:17 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	147	0	2015	First Health Part D Value Plus - Kansas		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	148	0		29	10	S5768_148_0	1		1	05/29/2014	2015.01	05/29/2014 07:49:02 AM Eastern Daylight Time		05/30/2014 05:39:57 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	148	0	2015	First Health Part D Value Plus - UpMidW_NoPlains		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	149	0		29	10	S5768_149_0	1		1	05/25/2014	2015.01	05/25/2014 05:15:29 PM Eastern Daylight Time		05/30/2014 05:40:05 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	149	0	2015	First Health Part D Value Plus - New Mexico		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	150	0		29	10	S5768_150_0	1		1	05/26/2014	2015.01	05/26/2014 06:44:15 AM Eastern Daylight Time		05/30/2014 05:40:13 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	150	0	2015	First Health Part D Value Plus - Colorado		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	151	0		29	10	S5768_151_0	1		1	05/25/2014	2015.01	05/25/2014 05:23:41 PM Eastern Daylight Time		05/30/2014 05:40:21 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	151	0	2015	First Health Part D Value Plus - Arizona		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	152	0		29	10	S5768_152_0	1		1	05/26/2014	2015.01	05/26/2014 06:50:47 AM Eastern Daylight Time		05/30/2014 05:40:30 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	152	0	2015	First Health Part D Value Plus - Nevada		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	153	0		29	10	S5768_153_0	1		1	05/25/2014	2015.01	05/25/2014 05:16:36 PM Eastern Daylight Time		05/30/2014 05:40:38 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	153	0	2015	First Health Part D Value Plus - OR_WA		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	154	0		29	10	S5768_154_0	1		1	05/26/2014	2015.01	05/26/2014 06:51:52 AM Eastern Daylight Time		05/30/2014 05:40:46 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	154	0	2015	First Health Part D Value Plus - Idaho_Utah		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	155	0		29	10	S5768_155_0	1		1	05/25/2014	2015.01	05/25/2014 05:17:32 PM Eastern Daylight Time		05/30/2014 05:40:55 PM Eastern Daylight Time			05/31/2014 01:34:33 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	155	0	2015	First Health Part D Value Plus - California		2					2								www.FHDFormulary.coventry-medicare.com	www.PharmacyLocator.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	164	0		29	10	S5768_164_0	2		1	07/02/2014	2015.01	07/02/2014 09:49:53 AM Eastern Daylight Time		05/30/2014 05:41:03 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	164	0	2015	Mid-Atlantic (DE,DC,MD)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	165	0		29	10	S5768_165_0	2		1	07/02/2014	2015.01	07/02/2014 09:50:05 AM Eastern Daylight Time		05/30/2014 05:41:11 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	165	0	2015	Pennsylvania, West Virginia		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	166	0		29	10	S5768_166_0	2		1	07/02/2014	2015.01	07/02/2014 09:50:20 AM Eastern Daylight Time		05/30/2014 05:41:20 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	166	0	2015	Virginia		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	167	0		29	10	S5768_167_0	2		1	07/02/2014	2015.01	07/02/2014 09:50:33 AM Eastern Daylight Time		05/30/2014 05:41:28 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	167	0	2015	North Carolina		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	168	0		29	10	S5768_168_0	2		1	07/02/2014	2015.01	07/02/2014 09:50:46 AM Eastern Daylight Time		05/30/2014 05:41:36 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	168	0	2015	South Carolina		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	169	0		29	10	S5768_169_0	2		1	07/02/2014	2015.01	07/02/2014 09:50:57 AM Eastern Daylight Time		05/30/2014 05:41:45 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	169	0	2015	Georgia		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	170	0		29	10	S5768_170_0	2		1	07/02/2014	2015.01	07/02/2014 09:51:08 AM Eastern Daylight Time		05/30/2014 05:41:53 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	170	0	2015	Alabama, Tennessee		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	171	0		29	10	S5768_171_0	2		1	07/02/2014	2015.01	07/02/2014 09:51:19 AM Eastern Daylight Time		05/30/2014 05:42:01 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	171	0	2015	Michigan		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	172	0		29	10	S5768_172_0	2		1	07/02/2014	2015.01	07/02/2014 09:51:35 AM Eastern Daylight Time		05/30/2014 05:42:10 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	172	0	2015	Ohio		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	173	0		29	10	S5768_173_0	2		1	07/02/2014	2015.01	07/02/2014 09:51:49 AM Eastern Daylight Time		05/30/2014 05:42:18 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	173	0	2015	Wisconsin		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	174	0		29	10	S5768_174_0	2		1	07/02/2014	2015.01	07/02/2014 09:52:01 AM Eastern Daylight Time		05/30/2014 05:42:27 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	174	0	2015	Illinois		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	175	0		29	10	S5768_175_0	2		1	07/02/2014	2015.01	07/02/2014 09:52:13 AM Eastern Daylight Time		05/30/2014 05:42:36 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	175	0	2015	Missouri		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	176	0		29	10	S5768_176_0	2		1	07/02/2014	2015.01	07/02/2014 09:52:28 AM Eastern Daylight Time		05/30/2014 05:42:44 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	176	0	2015	Arkansas		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	177	0		29	10	S5768_177_0	2		1	07/02/2014	2015.01	07/02/2014 09:52:42 AM Eastern Daylight Time		05/30/2014 05:42:52 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	177	0	2015	Mississippi		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	178	0		29	10	S5768_178_0	2		1	07/02/2014	2015.01	07/02/2014 09:52:53 AM Eastern Daylight Time		05/30/2014 05:43:00 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	178	0	2015	Louisiana		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	179	0		29	10	S5768_179_0	2		1	07/02/2014	2015.01	07/02/2014 09:53:06 AM Eastern Daylight Time		05/30/2014 05:43:09 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	179	0	2015	Texas		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	180	0		29	10	S5768_180_0	2		1	07/02/2014	2015.01	07/02/2014 09:53:18 AM Eastern Daylight Time		05/30/2014 05:43:18 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	180	0	2015	Oklahoma		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	181	0		29	10	S5768_181_0	2		1	07/02/2014	2015.01	07/02/2014 09:53:29 AM Eastern Daylight Time		05/30/2014 05:43:26 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	181	0	2015	Kansas		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	182	0		29	10	S5768_182_0	2		1	07/11/2014	2015.01	07/11/2014 02:00:24 PM Eastern Daylight Time		05/30/2014 05:43:34 PM Eastern Daylight Time			07/11/2014 02:38:12 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	182	0	2015	Colorado		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	183	0		29	10	S5768_183_0	2		1	07/02/2014	2015.01	07/02/2014 09:53:53 AM Eastern Daylight Time		05/30/2014 05:43:42 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	183	0	2015	Arizona		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	184	0		29	10	S5768_184_0	2		1	07/02/2014	2015.01	07/02/2014 09:54:05 AM Eastern Daylight Time		05/30/2014 05:43:51 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	184	0	2015	Nevada		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	185	0		29	10	S5768_185_0	2		1	07/02/2014	2015.01	07/02/2014 09:54:16 AM Eastern Daylight Time		05/30/2014 05:43:59 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	185	0	2015	Northern New England (NH, ME)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	186	0		29	10	S5768_186_0	2		1	07/02/2014	2015.01	07/02/2014 09:54:27 AM Eastern Daylight Time		05/30/2014 05:44:07 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	186	0	2015	Central New England  (CT,RI, MA,VT)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	187	0		29	10	S5768_187_0	2		1	07/02/2014	2015.01	07/02/2014 09:54:37 AM Eastern Daylight Time		05/30/2014 05:44:15 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	187	0	2015	New Jersey		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	188	0		29	10	S5768_188_0	2		1	07/02/2014	2015.01	07/02/2014 09:54:51 AM Eastern Daylight Time		05/30/2014 05:44:24 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	188	0	2015	Florida		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	189	0		29	10	S5768_189_0	2		1	07/02/2014	2015.01	07/02/2014 09:55:02 AM Eastern Daylight Time		05/30/2014 05:44:32 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	189	0	2015	Indiana, Kentucky		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	190	0		29	10	S5768_190_0	2		1	07/02/2014	2015.01	07/02/2014 09:55:16 AM Eastern Daylight Time		05/30/2014 05:44:41 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	190	0	2015	Upper MW and N Plains (IA,MN,NE,SD,ND,WY,MT)		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	191	0		29	10	S5768_191_0	2		1	07/02/2014	2015.01	07/02/2014 09:55:30 AM Eastern Daylight Time		05/30/2014 05:44:50 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	191	0	2015	New Mexico		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	192	0		29	10	S5768_192_0	2		1	07/02/2014	2015.01	07/02/2014 09:55:40 AM Eastern Daylight Time		05/30/2014 05:44:59 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	192	0	2015	Oregon, Washington		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	193	0		29	10	S5768_193_0	2		1	07/02/2014	2015.01	07/02/2014 09:55:52 AM Eastern Daylight Time		05/30/2014 05:45:07 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	193	0	2015	Idaho, Utah		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	194	0		29	10	S5768_194_0	2		1	07/02/2014	2015.01	07/02/2014 09:56:01 AM Eastern Daylight Time		05/30/2014 05:45:15 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	194	0	2015	California		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	195	0		29	10	S5768_195_0	3		1	07/17/2014	2015.01	07/17/2014 12:04:21 PM Eastern Daylight Time		07/08/2014 11:51:48 AM Eastern Daylight Time			07/17/2014 12:12:01 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	195	0	2015	Hawaii		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	196	0		29	10	S5768_196_0	2		1	07/02/2014	2015.01	07/02/2014 09:56:26 AM Eastern Daylight Time		05/30/2014 05:45:33 PM Eastern Daylight Time			07/02/2014 12:34:09 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Premier Plus (PDP)	10	29					S5768	196	0	2015	Alaska		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	197	0		29	10	S5768_197_0	1		1	05/27/2014	2015.01	05/27/2014 10:44:15 AM Eastern Daylight Time		05/30/2014 05:45:41 PM Eastern Daylight Time			05/31/2014 02:09:51 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	197	0	2015	Alaska		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5768	198	0		29	10	S5768_198_0	1		1	05/31/2014	2015.01	05/31/2014 02:05:20 PM Eastern Daylight Time		05/30/2014 05:45:50 PM Eastern Daylight Time			05/31/2014 02:09:51 PM Eastern Daylight Time	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	First Health Part D	www.FirstHealthPartD.com	First Health Part D Value Plus (PDP)	10	29					S5768	198	0	2015	Hawaii		2					2								http://www.FHDFormulary.coventry-medicare.com	http://www.FHDPharmacy.coventry-medicare.com									(866)865-0662		(866)865-0662		(855)893-4696		(855)893-4696										(711)-		(711)-		(711)-		(711)-												
S5795	002	0		29	10	S5795_002_0	2		1	05/28/2014	2015.01	05/28/2014 06:51:08 PM Central Daylight Time		05/31/2014 12:04:20 AM Central Daylight Time			05/31/2014 12:12:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Rx Premier (PDP)	10	29					S5795	002	0	2015	State of Arkansas		2					2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869												
S5795	003	0		29	10	S5795_003_0	2		1	05/28/2014	2015.01	05/28/2014 06:52:35 PM Central Daylight Time		05/31/2014 12:07:43 AM Central Daylight Time			05/31/2014 12:12:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	AR Blue Cross - Medi-Pak Rx Basic (PDP)	10	29					S5795	003	0	2015	State of Arkansas		2					2								http://www.arkansasbluecross.com/LookingForInsurance/MedicarePlans/default.aspx	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869												
S5795	804	0		29	10	S5795_804_0	2		1	05/27/2014	2015.01	05/27/2014 01:47:24 PM Central Daylight Time					05/31/2014 12:12:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer CY 4 (PDP)	10	29					S5795	804	0	2015	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869												
S5795	809	0		29	10	S5795_809_0	2		1	05/27/2014	2015.01	05/27/2014 01:47:31 PM Central Daylight Time					05/31/2014 12:12:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	Arkansas BCBS Std Def Employer NCY 4 (PDP)	10	29					S5795	809	0	2015	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869												
S5795	811	0		29	10	S5795_811_0	2		1	05/27/2014	2015.01	05/27/2014 01:47:38 PM Central Daylight Time					05/31/2014 12:12:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	ABCBS Group Basic CY (PDP)	10	29					S5795	811	0	2015	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869												
S5795	812	0		29	10	S5795_812_0	2		1	05/27/2014	2015.01	05/27/2014 01:47:43 PM Central Daylight Time					05/31/2014 12:12:58 PM Central Daylight Time	USABLE MUTUAL INSURANCE COMPANY	ARKANSAS BLUE CROSS AND BLUE SHIELD	www.arkansasbluecross.com	ABCBS Group Basic PY (PDP)	10	29					S5795	812	0	2015	Employer Group Plan		1					2								http://www.arkansasbluecross.com	http://www.arkansasbluecross.com									(866)390-3369		(866)390-3369		(888)242-5017		(888)242-5017										(888)844-5530		(888)844-5530		(800)370-5869		(800)370-5869												
S5805	001	0		29	10	S5805_001_0	1		1	05/28/2014	2015.02	05/28/2014 03:54:35 PM Central Daylight Time		05/30/2014 02:38:51 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5805	001	0	2015	New York		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5805	803	0		29	10	S5805_803_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:32 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	803	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	804	0		29	10	S5805_804_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:39 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	804	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	807	0		29	10	S5805_807_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:44 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	807	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	808	0		29	10	S5805_808_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:47 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	808	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	809	0		29	10	S5805_809_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:50 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	809	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	810	0		29	10	S5805_810_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:52 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	810	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	811	0		29	10	S5805_811_0	1		1	05/05/2014	2015.02	05/05/2014 10:42:32 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	811	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	812	0		29	10	S5805_812_0	1		1	04/18/2014	2015.02	04/18/2014 10:23:58 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	812	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	813	0		29	10	S5805_813_0	1		1	04/18/2014	2015.02	04/18/2014 10:24:00 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	813	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	814	0		29	10	S5805_814_0	1		1	04/18/2014	2015.02	04/18/2014 10:24:03 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	814	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	815	0		29	10	S5805_815_0	1		1	04/18/2014	2015.02	04/18/2014 10:24:05 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	815	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	816	0		29	10	S5805_816_0	1		1	04/18/2014	2015.02	04/18/2014 10:24:08 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	816	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	818	0		29	10	S5805_818_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:39 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	818	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	819	0		29	10	S5805_819_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:43 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	819	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	820	0		29	10	S5805_820_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:47 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	820	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	821	0		29	10	S5805_821_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:50 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	821	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	822	0		29	10	S5805_822_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:53 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	822	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	823	0		29	10	S5805_823_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:56 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	823	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	824	0		29	10	S5805_824_0	2		1	06/02/2014	2015.02	06/02/2014 09:25:59 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	824	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	825	0		29	10	S5805_825_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:02 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	825	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	826	0		29	10	S5805_826_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:04 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	826	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	827	0		29	10	S5805_827_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:07 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	827	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5805	828	0		29	10	S5805_828_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:10 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5805	828	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5810	035	0		29	10	S5810_035_0	3		1	05/26/2014	2015.01	05/26/2014 11:51:12 AM Eastern Daylight Time		05/30/2014 05:45:58 PM Eastern Daylight Time			05/31/2014 11:25:23 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	035	0	2015	Northern New England (NH, ME)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	036	0		29	10	S5810_036_0	2		1	05/26/2014	2015.01	05/26/2014 10:03:55 AM Eastern Daylight Time		05/30/2014 05:46:07 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	036	0	2015	Central New England  (CT,RI, MA,VT)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	037	0		29	10	S5810_037_0	2		1	05/26/2014	2015.01	05/26/2014 10:23:57 AM Eastern Daylight Time		05/30/2014 05:46:15 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	037	0	2015	New  York		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	038	0		29	10	S5810_038_0	2		1	05/26/2014	2015.01	05/26/2014 10:32:38 AM Eastern Daylight Time		05/30/2014 05:46:24 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	038	0	2015	New Jersey		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	039	0		29	10	S5810_039_0	2		1	05/26/2014	2015.01	05/26/2014 10:02:05 AM Eastern Daylight Time		05/30/2014 05:46:32 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	039	0	2015	Mid-Atlantic (DE,DC,MD)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	040	0		29	10	S5810_040_0	2		1	05/26/2014	2015.01	05/26/2014 10:05:19 AM Eastern Daylight Time		05/30/2014 05:46:41 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	040	0	2015	Pennsylvania, West Virginia		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	041	0		29	10	S5810_041_0	2		1	05/26/2014	2015.01	05/26/2014 10:07:23 AM Eastern Daylight Time		05/30/2014 05:46:49 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	041	0	2015	Virginia		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	042	0		29	10	S5810_042_0	2		1	05/26/2014	2015.01	05/26/2014 10:52:00 AM Eastern Daylight Time		05/30/2014 05:46:58 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	042	0	2015	North Carolina		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	043	0		29	10	S5810_043_0	1		1	05/26/2014	2015.01	05/26/2014 10:29:18 PM Eastern Daylight Time		05/30/2014 05:47:07 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	043	0	2015	South Carolina		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	044	0		29	10	S5810_044_0	1		1	05/26/2014	2015.01	05/26/2014 10:56:04 AM Eastern Daylight Time		05/30/2014 05:47:15 PM Eastern Daylight Time			05/31/2014 01:01:55 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	044	0	2015	Georgia		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	045	0		29	10	S5810_045_0	2		1	05/26/2014	2015.01	05/26/2014 01:59:10 PM Eastern Daylight Time		05/30/2014 05:47:24 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	045	0	2015	Florida		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	046	0		29	10	S5810_046_0	2		1	05/26/2014	2015.01	05/26/2014 09:07:57 AM Eastern Daylight Time		05/30/2014 05:47:33 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	046	0	2015	Alabama, Tennessee		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	047	0		29	10	S5810_047_0	2		1	05/26/2014	2015.01	05/26/2014 09:44:18 AM Eastern Daylight Time		05/30/2014 05:47:41 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	047	0	2015	Michigan		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	048	0		29	10	S5810_048_0	2		1	05/26/2014	2015.01	05/26/2014 09:09:47 AM Eastern Daylight Time		05/30/2014 05:47:50 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	048	0	2015	Ohio		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	049	0		29	10	S5810_049_0	2		1	05/26/2014	2015.01	05/26/2014 10:08:34 AM Eastern Daylight Time		05/30/2014 05:47:58 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	049	0	2015	Indiana, Kentucky		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	050	0		29	10	S5810_050_0	2		1	05/26/2014	2015.01	05/26/2014 10:09:57 AM Eastern Daylight Time		05/30/2014 05:48:06 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	050	0	2015	Wisconsin		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	051	0		29	10	S5810_051_0	2		1	05/26/2014	2015.01	05/26/2014 11:06:38 AM Eastern Daylight Time		05/30/2014 05:48:15 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	051	0	2015	Illinois		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	052	0		29	10	S5810_052_0	2		1	05/26/2014	2015.01	05/26/2014 09:13:36 AM Eastern Daylight Time		05/30/2014 05:48:24 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	052	0	2015	Missouri		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	053	0		29	10	S5810_053_0	2		1	05/26/2014	2015.01	05/26/2014 09:47:32 AM Eastern Daylight Time		05/30/2014 05:48:32 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	053	0	2015	Arkansas		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	054	0		29	10	S5810_054_0	2		1	05/26/2014	2015.01	05/26/2014 11:13:08 AM Eastern Daylight Time		05/30/2014 05:48:40 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	054	0	2015	Mississippi		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	055	0		29	10	S5810_055_0	2		1	05/26/2014	2015.01	05/26/2014 10:16:38 AM Eastern Daylight Time		05/30/2014 05:48:49 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	055	0	2015	Louisiana		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	056	0		29	10	S5810_056_0	2		1	05/26/2014	2015.01	05/26/2014 11:32:23 AM Eastern Daylight Time		05/30/2014 05:48:58 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	056	0	2015	Texas		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	057	0		29	10	S5810_057_0	2		1	05/26/2014	2015.01	05/26/2014 10:14:44 AM Eastern Daylight Time		05/30/2014 05:49:06 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	057	0	2015	Oklahoma		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	058	0		29	10	S5810_058_0	2		1	05/26/2014	2015.01	05/26/2014 09:15:27 AM Eastern Daylight Time		05/30/2014 05:49:15 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	058	0	2015	Kansas		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	059	0		29	10	S5810_059_0	2		1	05/26/2014	2015.01	05/26/2014 09:17:34 AM Eastern Daylight Time		05/30/2014 05:49:23 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	059	0	2015	Upper MW and N Plains (IA,MN,NE,SD,ND,WY,MT)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	060	0		29	10	S5810_060_0	2		1	05/28/2014	2015.01	05/28/2014 04:27:28 PM Eastern Daylight Time		05/30/2014 05:49:32 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	060	0	2015	New Mexico		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	061	0		29	10	S5810_061_0	2		1	05/26/2014	2015.01	05/26/2014 09:20:30 AM Eastern Daylight Time		05/30/2014 05:49:40 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	061	0	2015	Colorado		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	062	0		29	10	S5810_062_0	2		1	05/26/2014	2015.01	05/26/2014 01:00:20 PM Eastern Daylight Time		05/30/2014 05:49:49 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	062	0	2015	Arizona		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	063	0		29	10	S5810_063_0	2		1	05/26/2014	2015.01	05/26/2014 10:30:05 PM Eastern Daylight Time		05/30/2014 05:49:58 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	063	0	2015	Nevada		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	064	0		29	10	S5810_064_0	2		1	05/26/2014	2015.01	05/26/2014 09:49:01 AM Eastern Daylight Time		05/30/2014 05:50:07 PM Eastern Daylight Time			05/31/2014 02:34:00 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	064	0	2015	Oregon, Washington		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	065	0		29	10	S5810_065_0	1		1	05/26/2014	2015.01	05/26/2014 09:23:25 AM Eastern Daylight Time		05/30/2014 05:50:16 PM Eastern Daylight Time			05/31/2014 02:25:43 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	065	0	2015	Idaho, Utah		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	066	0		29	10	S5810_066_0	1		1	05/28/2014	2015.01	05/28/2014 04:38:54 PM Eastern Daylight Time		05/30/2014 05:50:24 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	066	0	2015	California		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	067	0		29	10	S5810_067_0	1		1	05/26/2014	2015.01	05/26/2014 11:37:10 AM Eastern Daylight Time		05/30/2014 05:50:33 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	067	0	2015	Hawaii		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	068	0		29	10	S5810_068_0	1		1	05/26/2014	2015.01	05/26/2014 11:48:40 AM Eastern Daylight Time		05/30/2014 05:50:42 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Saver (PDP)	10	29					S5810	068	0	2015	Alaska		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	172	0		29	10	S5810_172_0	1		1	05/27/2014	2015.01	05/27/2014 09:20:54 AM Eastern Daylight Time		05/30/2014 05:50:50 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	172	0	2015	Central New England  (CT,RI, MA,VT)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	174	0		29	10	S5810_174_0	1		1	05/27/2014	2015.01	05/27/2014 09:24:55 AM Eastern Daylight Time		05/30/2014 05:50:59 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	174	0	2015	New Jersey		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	175	0		29	10	S5810_175_0	1		1	05/27/2014	2015.01	05/27/2014 09:26:45 AM Eastern Daylight Time		05/30/2014 05:51:08 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	175	0	2015	Mid-Atlantic (DE,DC,MD)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	176	0		29	10	S5810_176_0	1		1	05/28/2014	2015.01	05/28/2014 09:33:27 AM Eastern Daylight Time		05/30/2014 05:51:17 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	176	0	2015	Pennsylvania, West Virginia		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	177	0		29	10	S5810_177_0	1		1	05/27/2014	2015.01	05/27/2014 09:28:57 AM Eastern Daylight Time		05/30/2014 05:51:26 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	177	0	2015	Virginia		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	178	0		29	10	S5810_178_0	1		1	05/27/2014	2015.01	05/27/2014 09:34:47 AM Eastern Daylight Time		05/30/2014 05:51:34 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	178	0	2015	North Carolina		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	179	0		29	10	S5810_179_0	1		1	05/27/2014	2015.01	05/27/2014 09:40:37 AM Eastern Daylight Time		05/30/2014 05:51:43 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	179	0	2015	South Carolina		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	180	0		29	10	S5810_180_0	1		1	05/27/2014	2015.01	05/27/2014 09:46:13 AM Eastern Daylight Time		05/30/2014 05:51:52 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	180	0	2015	Georgia		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	182	0		29	10	S5810_182_0	1		1	05/27/2014	2015.01	05/27/2014 09:48:36 AM Eastern Daylight Time		05/30/2014 05:52:01 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	182	0	2015	Alabama, Tennessee		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	183	0		29	10	S5810_183_0	1		1	05/27/2014	2015.01	05/27/2014 09:49:23 AM Eastern Daylight Time		05/30/2014 05:52:09 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	183	0	2015	Michigan		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	184	0		29	10	S5810_184_0	1		1	05/27/2014	2015.01	05/27/2014 09:50:16 AM Eastern Daylight Time		05/30/2014 05:52:19 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	184	0	2015	Ohio		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	185	0		29	10	S5810_185_0	1		1	05/27/2014	2015.01	05/27/2014 09:51:19 AM Eastern Daylight Time		05/30/2014 05:52:28 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	185	0	2015	Indiana, Kentucky		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	186	0		29	10	S5810_186_0	1		1	05/27/2014	2015.01	05/27/2014 09:52:57 AM Eastern Daylight Time		05/30/2014 05:52:36 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	186	0	2015	Wisconsin		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	187	0		29	10	S5810_187_0	1		1	05/27/2014	2015.01	05/27/2014 09:54:54 AM Eastern Daylight Time		05/30/2014 05:52:44 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	187	0	2015	Illinois		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	188	0		29	10	S5810_188_0	1		1	05/27/2014	2015.01	05/27/2014 09:57:37 AM Eastern Daylight Time		05/30/2014 05:52:53 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	188	0	2015	Missouri		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	189	0		29	10	S5810_189_0	1		1	05/27/2014	2015.01	05/27/2014 09:58:51 AM Eastern Daylight Time		05/30/2014 05:53:02 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	189	0	2015	Arkansas		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	190	0		29	10	S5810_190_0	1		1	05/27/2014	2015.01	05/27/2014 10:55:08 AM Eastern Daylight Time		05/30/2014 05:53:12 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	190	0	2015	Mississippi		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	191	0		29	10	S5810_191_0	1		1	05/27/2014	2015.01	05/27/2014 10:56:36 AM Eastern Daylight Time		05/30/2014 05:53:21 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	191	0	2015	Louisiana		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	192	0		29	10	S5810_192_0	1		1	05/27/2014	2015.01	05/27/2014 10:57:09 AM Eastern Daylight Time		05/30/2014 05:53:29 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	192	0	2015	Texas		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	193	0		29	10	S5810_193_0	1		1	05/27/2014	2015.01	05/27/2014 11:21:08 AM Eastern Daylight Time		05/30/2014 05:53:38 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	193	0	2015	Oklahoma		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	194	0		29	10	S5810_194_0	1		1	05/27/2014	2015.01	05/27/2014 11:27:39 AM Eastern Daylight Time		05/30/2014 05:53:47 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	194	0	2015	Kansas		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	195	0		29	10	S5810_195_0	1		1	05/27/2014	2015.01	05/27/2014 11:28:46 AM Eastern Daylight Time		05/30/2014 05:53:56 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	195	0	2015	Upper MW and N Plains (IA,MN,NE,SD,ND,WY,MT)		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	197	0		29	10	S5810_197_0	1		1	05/27/2014	2015.01	05/27/2014 11:55:33 AM Eastern Daylight Time		05/30/2014 05:54:05 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	197	0	2015	Colorado		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	198	0		29	10	S5810_198_0	1		1	05/27/2014	2015.01	05/27/2014 11:56:52 AM Eastern Daylight Time		05/30/2014 05:54:14 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	198	0	2015	Arizona		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	199	0		29	10	S5810_199_0	1		1	05/27/2014	2015.01	05/27/2014 11:58:00 AM Eastern Daylight Time		05/30/2014 05:54:22 PM Eastern Daylight Time			05/31/2014 02:43:02 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	199	0	2015	Nevada		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	200	0		29	10	S5810_200_0	1		1	05/27/2014	2015.01	05/27/2014 12:00:00 PM Eastern Daylight Time		05/30/2014 05:54:31 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	200	0	2015	Oregon, Washington		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	201	0		29	10	S5810_201_0	1		1	05/27/2014	2015.01	05/27/2014 12:01:10 PM Eastern Daylight Time		05/30/2014 05:54:40 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	201	0	2015	Idaho, Utah		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	202	0		29	10	S5810_202_0	1		1	05/25/2014	2015.01	05/25/2014 01:42:28 PM Eastern Daylight Time		05/30/2014 05:54:50 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	202	0	2015	California		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	204	0		29	10	S5810_204_0	1		1	05/27/2014	2015.01	05/27/2014 12:16:39 PM Eastern Daylight Time		05/30/2014 05:54:58 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	204	0	2015	Alaska		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	239	0		29	10	S5810_239_0	1		1	05/27/2014	2015.01	05/27/2014 09:23:03 AM Eastern Daylight Time		05/30/2014 05:55:07 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	239	0	2015	New York		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	240	0		29	10	S5810_240_0	1		1	05/27/2014	2015.01	05/27/2014 09:47:21 AM Eastern Daylight Time		05/30/2014 05:55:16 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	240	0	2015	Florida		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	241	0		29	10	S5810_241_0	1		1	05/27/2014	2015.01	05/27/2014 11:53:52 AM Eastern Daylight Time		05/30/2014 05:55:25 PM Eastern Daylight Time			05/31/2014 02:49:21 PM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Premier (PDP)	10	29					S5810	241	0	2015	New Mexico		2					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	801	0		29	10	S5810_801_0	1		1	05/31/2014	2015.01	05/31/2014 02:19:56 PM Eastern Daylight Time					06/01/2014 10:31:40 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Plan (PDP)	10	29					S5810	801	0	2015	Employer National		1					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5810	804	0		29	10	S5810_804_0	1		1	05/31/2014	2015.01	05/31/2014 02:20:03 PM Eastern Daylight Time					06/01/2014 10:31:40 AM Eastern Daylight Time	AETNA LIFE INSURANCE COMPANY	Aetna Medicare	www.aetnamedicare.com	Aetna Medicare Rx Plan (PDP)	10	29					S5810	804	0	2015	Employer National		1					2								www.aetnamedicare.com/plan_choices/rx_find_prescriptions.jsp	www.aetnapharmacy.com									(877)238-6211		(877)238-6211		(800)832-2640		(800)832-2640										(711)-		(711)-		(711)-		(711)-												
S5820	001	0		29	10	S5820_001_0	1		1	05/27/2014	2015.02	05/27/2014 07:25:05 PM Central Daylight Time		05/30/2014 02:38:55 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	001	0	2015	Northern New England (NH, ME)		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	002	0		29	10	S5820_002_0	1		1	05/28/2014	2015.02	05/28/2014 02:28:01 PM Central Daylight Time		05/30/2014 02:38:59 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	002	0	2015	Central New England (CT, MA, RI, VT)		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	003	0		29	10	S5820_003_0	1		1	05/28/2014	2015.02	05/28/2014 02:28:49 PM Central Daylight Time		05/30/2014 02:39:03 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	003	0	2015	New Jersey		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	004	0		29	10	S5820_004_0	1		1	05/28/2014	2015.02	05/28/2014 02:30:13 PM Central Daylight Time		05/30/2014 02:39:07 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	004	0	2015	Mid-Atlantic (DE, DC, MD)		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	005	0		29	10	S5820_005_0	1		1	05/28/2014	2015.02	05/28/2014 03:42:59 PM Central Daylight Time		05/30/2014 02:39:10 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	005	0	2015	Pennsylvania, West Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	006	0		29	10	S5820_006_0	1		1	05/28/2014	2015.02	05/28/2014 03:46:13 PM Central Daylight Time		05/30/2014 02:39:14 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	006	0	2015	Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	007	0		29	10	S5820_007_0	1		1	05/28/2014	2015.02	05/28/2014 02:37:00 PM Central Daylight Time		05/30/2014 02:39:18 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	007	0	2015	North Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	008	0		29	10	S5820_008_0	1		1	05/28/2014	2015.02	05/28/2014 02:38:13 PM Central Daylight Time		05/30/2014 02:39:23 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	008	0	2015	South Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	009	0		29	10	S5820_009_0	1		1	05/27/2014	2015.02	05/27/2014 08:31:03 PM Central Daylight Time		05/30/2014 02:39:27 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	009	0	2015	Georgia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	010	0		29	10	S5820_010_0	1		1	05/27/2014	2015.02	05/27/2014 08:34:22 PM Central Daylight Time		05/30/2014 02:39:30 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	010	0	2015	Florida		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	011	0		29	10	S5820_011_0	1		1	05/27/2014	2015.02	05/27/2014 10:39:55 PM Central Daylight Time		05/30/2014 02:39:34 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	011	0	2015	Alabama, Tennessee		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	012	0		29	10	S5820_012_0	1		1	05/27/2014	2015.02	05/27/2014 08:14:23 PM Central Daylight Time		05/30/2014 02:39:38 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	012	0	2015	Michigan		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	013	0		29	10	S5820_013_0	1		1	05/27/2014	2015.02	05/27/2014 10:47:24 PM Central Daylight Time		05/30/2014 02:39:42 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	013	0	2015	Ohio		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	014	0		29	10	S5820_014_0	1		1	05/27/2014	2015.02	05/27/2014 08:18:48 PM Central Daylight Time		05/30/2014 02:39:45 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	014	0	2015	Indiana, Kentucky		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	015	0		29	10	S5820_015_0	1		1	05/27/2014	2015.02	05/27/2014 11:12:35 PM Central Daylight Time		05/30/2014 02:39:49 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	015	0	2015	Wisconsin		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	016	0		29	10	S5820_016_0	1		1	05/28/2014	2015.02	05/28/2014 03:32:14 PM Central Daylight Time		05/30/2014 02:39:53 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	016	0	2015	Illinois		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	017	0		29	10	S5820_017_0	1		1	05/29/2014	2015.02	05/29/2014 09:46:30 AM Central Daylight Time		05/30/2014 02:39:57 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	017	0	2015	Missouri		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	018	0		29	10	S5820_018_0	1		1	05/27/2014	2015.02	05/27/2014 11:15:04 PM Central Daylight Time		05/30/2014 02:40:01 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	018	0	2015	Arkansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	019	0		29	10	S5820_019_0	1		1	05/27/2014	2015.02	05/27/2014 11:08:39 PM Central Daylight Time		05/30/2014 02:40:04 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	019	0	2015	Mississippi		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	020	0		29	10	S5820_020_0	1		1	05/27/2014	2015.02	05/27/2014 11:22:44 PM Central Daylight Time		05/30/2014 02:40:08 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	020	0	2015	Louisiana		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	021	0		29	10	S5820_021_0	1		1	05/27/2014	2015.02	05/27/2014 07:48:43 PM Central Daylight Time		05/30/2014 02:40:12 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	021	0	2015	Texas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	022	0		29	10	S5820_022_0	1		1	05/27/2014	2015.02	05/27/2014 08:21:26 PM Central Daylight Time		05/30/2014 02:40:16 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	022	0	2015	Oklahoma		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	023	0		29	10	S5820_023_0	1		1	05/27/2014	2015.02	05/27/2014 07:59:37 PM Central Daylight Time		05/30/2014 02:40:19 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	023	0	2015	Kansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	024	0		29	10	S5820_024_0	1		1	05/28/2014	2015.02	05/28/2014 02:42:44 PM Central Daylight Time		05/30/2014 02:40:23 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	024	0	2015	Upper Midwest and Northern Plains		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	025	0		29	10	S5820_025_0	1		1	05/28/2014	2015.02	05/28/2014 03:41:44 PM Central Daylight Time		05/30/2014 02:40:27 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	025	0	2015	New Mexico		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	026	0		29	10	S5820_026_0	1		1	05/27/2014	2015.02	05/27/2014 07:36:34 PM Central Daylight Time		05/30/2014 02:40:31 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	026	0	2015	Colorado		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	027	0		29	10	S5820_027_0	1		1	05/28/2014	2015.02	05/28/2014 03:34:09 PM Central Daylight Time		05/30/2014 02:40:34 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	027	0	2015	Arizona		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	028	0		29	10	S5820_028_0	1		1	05/27/2014	2015.02	05/27/2014 11:04:38 PM Central Daylight Time		05/30/2014 02:40:38 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	028	0	2015	Nevada		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	029	0		29	10	S5820_029_0	1		1	05/27/2014	2015.02	05/27/2014 08:03:01 PM Central Daylight Time		05/30/2014 02:40:42 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	029	0	2015	Oregon, Washington		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	030	0		29	10	S5820_030_0	1		1	05/27/2014	2015.02	05/27/2014 08:26:24 PM Central Daylight Time		05/30/2014 02:40:46 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	030	0	2015	Idaho, Utah		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	031	0		29	10	S5820_031_0	1		1	05/27/2014	2015.02	05/27/2014 10:49:15 PM Central Daylight Time		05/30/2014 02:40:49 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	031	0	2015	California		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	032	0		29	10	S5820_032_0	1		1	05/27/2014	2015.02	05/27/2014 07:38:17 PM Central Daylight Time		05/30/2014 02:40:53 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	032	0	2015	Hawaii		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	033	0		29	10	S5820_033_0	1		1	05/27/2014	2015.02	05/27/2014 08:28:11 PM Central Daylight Time		05/30/2014 02:40:57 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	033	0	2015	Alaska		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	034	0		29	10	S5820_034_0	3		1	05/31/2014	2015.02	05/31/2014 10:49:28 AM Central Daylight Time		06/02/2014 08:56:32 AM Central Daylight Time			06/02/2014 09:18:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	034	0	2015	American Samoa		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	035	0		29	10	S5820_035_0	1		1	05/29/2014	2015.02	05/29/2014 08:48:26 AM Central Daylight Time		05/30/2014 02:41:04 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	035	0	2015	Guam		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	036	0		29	10	S5820_036_0	3		1	05/31/2014	2015.02	05/31/2014 10:49:48 AM Central Daylight Time		06/02/2014 08:56:29 AM Central Daylight Time			06/02/2014 09:18:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	036	0	2015	Northern Mariana Islands		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	037	0		29	10	S5820_037_0	1		1	05/30/2014	2015.02	05/30/2014 01:35:58 PM Central Daylight Time		05/30/2014 02:41:12 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	037	0	2015	Puerto Rico		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	038	0		29	10	S5820_038_0	2		1	05/28/2014	2015.02	05/28/2014 11:31:26 AM Central Daylight Time		06/02/2014 08:56:27 AM Central Daylight Time			06/02/2014 09:18:24 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Preferred (PDP)	10	29					S5820	038	0	2015	US Virgin Islands		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(888)867-5564		(888)867-5564										(711)-		(711)-		(711)-		(711)-												
S5820	803	0		29	10	S5820_803_0	1		1	05/05/2014	2015.02	05/05/2014 10:41:51 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	803	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	804	0		29	10	S5820_804_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:22 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	804	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	807	0		29	10	S5820_807_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:25 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	807	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	808	0		29	10	S5820_808_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:27 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	808	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	810	0		29	10	S5820_810_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:30 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	810	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	811	0		29	10	S5820_811_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:42 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	811	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	812	0		29	10	S5820_812_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:47 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	812	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	813	0		29	10	S5820_813_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:50 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	813	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	814	0		29	10	S5820_814_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:53 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	814	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	815	0		29	10	S5820_815_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:56 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	815	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	816	0		29	10	S5820_816_0	1		1	04/18/2014	2015.02	04/18/2014 10:37:58 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	816	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	817	0		29	10	S5820_817_0	1		1	04/18/2014	2015.02	04/18/2014 10:38:01 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	817	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	818	0		29	10	S5820_818_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:18 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	818	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	819	0		29	10	S5820_819_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:21 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	819	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	820	0		29	10	S5820_820_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:23 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	820	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	821	0		29	10	S5820_821_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:26 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	821	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	822	0		29	10	S5820_822_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:28 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	822	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	823	0		29	10	S5820_823_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:30 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	823	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	824	0		29	10	S5820_824_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:33 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	824	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	825	0		29	10	S5820_825_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:36 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	825	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5820	826	0		29	10	S5820_826_0	2		1	06/02/2014	2015.02	06/02/2014 09:26:38 AM Central Daylight Time					06/02/2014 09:28:35 AM Central Daylight Time	UNITEDHEALTHCARE INSURANCE COMPANY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5820	826	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5857	802	0		29	10	S5857_802_0	2		1	05/27/2014	2015.02	05/27/2014 03:02:57 PM Eastern Daylight Time					05/30/2014 12:32:34 PM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Non-Calendar Year (PDP)	10	29					S5857	802	0	2015	United States		1					2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-												
S5857	803	0		29	10	S5857_803_0	2		1	05/27/2014	2015.02	05/27/2014 03:02:11 PM Eastern Daylight Time					05/30/2014 12:32:34 PM Eastern Daylight Time	PRIORITY HEALTH INSURANCE COMPANY	Priority Health Medicare	www.prioritymedicare.com	PriorityMedicare Rx EG Calendar Year (PDP)	10	29					S5857	803	0	2015	United States		1					2							www.prioritymedicare.com	www.prioritymedicare.com	www.prioritymedicare.com									(888)389-6648		(616)464-8820		(888)389-6676		(616)464-8850										(711)-		(711)-		(711)-		(711)-												
S5877	004	0		29	10	S5877_004_0	3		1	05/30/2014	2015.01	05/30/2014 08:30:25 AM Mountain Daylight Time		07/10/2014 03:36:47 PM Mountain Daylight Time			07/10/2014 03:41:59 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	http://medicare.emihealth.com/	Educators Rx Basic (PDP)	10	29					S5877	004	0	2015	State of Utah and State of Idaho		2					2								https://medicare.emihealth.com/Formulary.aspx	http://www.express-scripts.com									(800)572-8734		(801)262-7475		(888)236-4823		(801)262-7475										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5877	007	0		29	10	S5877_007_0	3		1	06/02/2014	2015.01	06/02/2014 09:05:30 AM Mountain Daylight Time		07/10/2014 03:36:47 PM Mountain Daylight Time			07/10/2014 03:41:59 PM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	http://medicare.emihealth.com/	Educators Rx Advantage (PDP)	10	29					S5877	007	0	2015	State of Utah and State of Idaho		2					2								https://medicare.emihealth.com/Formulary.aspx	http://www.express-scripts.com									(800)572-8734		(801)262-7475		(888)236-4823		(801)262-7475										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5877	801	0		29	10	S5877_801_0	2		1	05/30/2014	2015.01	05/30/2014 08:11:36 AM Mountain Daylight Time					06/02/2014 09:08:15 AM Mountain Daylight Time	EDUCATORS MUTUAL INSURANCE ASSOCIATION	EMI Health	http://medicare.emihealth.com/	Alpine School District Retiree Plan (PDP)	10	29					S5877	801	0	2015	State of Utah and State of Idaho		1					2								https://medicare.emihealth.com/Formulary.aspx	http://www.express-scripts.com									(800)572-8734		(801)262-7475		(888)236-4823		(801)262-7475										(800)716-3231		(800)716-3231		(711)-		(711)-												
S5884	001	0		29	10	S5884_001_0	2		1	07/21/2014	2015.02	07/21/2014 12:37:30 PM Eastern Daylight Time		07/22/2014 06:34:06 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	001	0	2015	States of Alabama and Tennessee		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	002	0		29	10	S5884_002_0	2		1	07/21/2014	2015.02	07/21/2014 12:36:41 PM Eastern Daylight Time		07/22/2014 06:34:06 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	002	0	2015	States of CT, MA, RI, VT		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	004	0		29	10	S5884_004_0	2		1	07/21/2014	2015.02	07/21/2014 12:35:43 PM Eastern Daylight Time		07/22/2014 06:34:06 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	004	0	2015	States of DC, DE, MD		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	005	0		29	10	S5884_005_0	2		1	07/21/2014	2015.02	07/21/2014 12:39:53 PM Eastern Daylight Time		07/22/2014 06:34:07 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	005	0	2015	States of Pennsylvania and West Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	008	0		29	10	S5884_008_0	2		1	07/21/2014	2015.02	07/21/2014 12:40:25 PM Eastern Daylight Time		07/22/2014 06:34:07 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	008	0	2015	State of South Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	009	0		29	10	S5884_009_0	2		1	07/21/2014	2015.02	07/21/2014 12:41:00 PM Eastern Daylight Time		07/22/2014 06:34:07 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	009	0	2015	State of Georgia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	010	0		29	10	S5884_010_0	2		1	07/21/2014	2015.02	07/21/2014 12:41:56 PM Eastern Daylight Time		07/22/2014 06:34:07 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	010	0	2015	State of Florida		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	015	0		29	10	S5884_015_0	2		1	07/21/2014	2015.02	07/21/2014 12:42:32 PM Eastern Daylight Time		07/22/2014 06:34:07 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	015	0	2015	State of Illinois		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	019	0		29	10	S5884_019_0	2		1	07/21/2014	2015.02	07/21/2014 12:43:06 PM Eastern Daylight Time		07/22/2014 06:34:07 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	019	0	2015	State of Louisiana		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	020	0		29	10	S5884_020_0	2		1	07/21/2014	2015.02	07/21/2014 12:43:41 PM Eastern Daylight Time		07/22/2014 06:34:08 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	020	0	2015	State of Texas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	021	0		29	10	S5884_021_0	2		1	07/21/2014	2015.02	07/21/2014 12:44:21 PM Eastern Daylight Time		07/22/2014 06:34:08 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	021	0	2015	State of Oklahoma		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	022	0		29	10	S5884_022_0	2		1	07/21/2014	2015.02	07/21/2014 12:45:05 PM Eastern Daylight Time		07/22/2014 06:34:08 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	022	0	2015	State of Kansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	024	0		29	10	S5884_024_0	2		1	07/21/2014	2015.02	07/21/2014 12:45:43 PM Eastern Daylight Time		07/22/2014 06:34:08 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	024	0	2015	State of New Mexico		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	028	0		29	10	S5884_028_0	2		1	07/21/2014	2015.02	07/21/2014 12:46:24 PM Eastern Daylight Time		07/22/2014 06:34:08 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	028	0	2015	States of Oregon and Washington		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	030	0		29	10	S5884_030_0	2		1	07/21/2014	2015.02	07/21/2014 12:46:54 PM Eastern Daylight Time		07/22/2014 06:34:09 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	030	0	2015	State of California		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	062	0		29	10	S5884_062_0	2		1	07/21/2014	2015.02	07/21/2014 12:47:27 PM Eastern Daylight Time		07/22/2014 06:34:09 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	062	0	2015	State of New Jersey		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	065	0		29	10	S5884_065_0	2		1	07/21/2014	2015.02	07/21/2014 12:48:02 PM Eastern Daylight Time		07/22/2014 06:34:09 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	065	0	2015	State of Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	066	0		29	10	S5884_066_0	2		1	07/21/2014	2015.02	07/21/2014 12:48:35 PM Eastern Daylight Time		07/22/2014 06:34:09 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	066	0	2015	State of North Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	071	0		29	10	S5884_071_0	2		1	07/21/2014	2015.02	07/21/2014 12:49:06 PM Eastern Daylight Time		07/22/2014 06:34:09 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	071	0	2015	State of Michigan		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	072	0		29	10	S5884_072_0	2		1	07/21/2014	2015.02	07/21/2014 12:49:36 PM Eastern Daylight Time		07/22/2014 06:34:10 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	072	0	2015	State of Ohio		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	073	0		29	10	S5884_073_0	2		1	07/21/2014	2015.02	07/21/2014 12:50:08 PM Eastern Daylight Time		07/22/2014 06:34:10 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	073	0	2015	States of Indiana and Kentucky		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	074	0		29	10	S5884_074_0	2		1	07/21/2014	2015.02	07/21/2014 12:50:38 PM Eastern Daylight Time		07/22/2014 06:34:10 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	074	0	2015	State of Wisconsin		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	076	0		29	10	S5884_076_0	2		1	07/21/2014	2015.02	07/21/2014 12:51:11 PM Eastern Daylight Time		07/22/2014 06:34:10 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	076	0	2015	State of Missouri		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	077	0		29	10	S5884_077_0	2		1	07/21/2014	2015.02	07/21/2014 12:51:43 PM Eastern Daylight Time		07/22/2014 06:34:10 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	077	0	2015	State of Arkansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	078	0		29	10	S5884_078_0	2		1	07/21/2014	2015.02	07/21/2014 12:52:20 PM Eastern Daylight Time		07/22/2014 06:34:10 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	078	0	2015	State of Mississippi		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	083	0		29	10	S5884_083_0	2		1	07/21/2014	2015.02	07/21/2014 12:52:52 PM Eastern Daylight Time		07/22/2014 06:34:11 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	083	0	2015	States of IA, MN, MT, ND, NE, SD, WY		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	085	0		29	10	S5884_085_0	2		1	07/21/2014	2015.02	07/21/2014 12:53:27 PM Eastern Daylight Time		07/22/2014 06:34:11 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	085	0	2015	State of Colorado		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	086	0		29	10	S5884_086_0	2		1	07/21/2014	2015.02	07/21/2014 12:54:04 PM Eastern Daylight Time		07/22/2014 06:34:11 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	086	0	2015	State of Arizona		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	087	0		29	10	S5884_087_0	2		1	07/21/2014	2015.02	07/21/2014 12:54:44 PM Eastern Daylight Time		07/22/2014 06:34:11 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	087	0	2015	State of Nevada		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	089	0		29	10	S5884_089_0	2		1	07/21/2014	2015.02	07/21/2014 12:55:21 PM Eastern Daylight Time		07/22/2014 06:34:11 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	089	0	2015	States of Idaho and Utah		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	092	0		29	10	S5884_092_0	2		1	07/21/2014	2015.02	07/21/2014 12:55:57 PM Eastern Daylight Time		07/22/2014 06:34:12 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	092	0	2015	States of Maine and New Hampshire		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	093	0		29	10	S5884_093_0	2		1	07/21/2014	2015.02	07/21/2014 12:56:48 PM Eastern Daylight Time		07/22/2014 06:34:12 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	093	0	2015	State of Hawaii		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	094	0		29	10	S5884_094_0	2		1	07/21/2014	2015.02	07/21/2014 12:57:21 PM Eastern Daylight Time		07/22/2014 06:34:12 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Enhanced (PDP)	10	29					S5884	094	0	2015	State of Alaska		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	101	0		29	10	S5884_101_0	1		1	05/21/2014	2015.02	05/21/2014 02:45:25 PM Eastern Daylight Time		05/27/2014 05:04:05 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	101	0	2015	States of New Hampshire and Maine		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	102	0		29	10	S5884_102_0	1		1	05/21/2014	2015.02	05/21/2014 02:45:42 PM Eastern Daylight Time		05/27/2014 05:04:05 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	102	0	2015	States of CT, MA, RI, VT		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	103	0		29	10	S5884_103_0	1		1	05/21/2014	2015.02	05/21/2014 02:46:19 PM Eastern Daylight Time		05/27/2014 05:04:06 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	103	0	2015	States of DC, DE, MD		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	104	0		29	10	S5884_104_0	1		1	05/21/2014	2015.02	05/21/2014 02:46:36 PM Eastern Daylight Time		05/27/2014 05:04:06 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	104	0	2015	States of Pennsylvania and West Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	105	0		29	10	S5884_105_0	1		1	05/21/2014	2015.02	05/21/2014 02:46:56 PM Eastern Daylight Time		05/27/2014 05:04:06 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	105	0	2015	State of Florida		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	106	0		29	10	S5884_106_0	1		1	05/21/2014	2015.02	05/21/2014 02:47:15 PM Eastern Daylight Time		05/27/2014 05:04:07 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	106	0	2015	States of Alabama and Tennessee		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	107	0		29	10	S5884_107_0	1		1	05/24/2014	2015.02	05/24/2014 01:12:10 PM Eastern Daylight Time		05/27/2014 05:04:07 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	107	0	2015	State of Illinois		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	108	0		29	10	S5884_108_0	1		1	05/21/2014	2015.02	05/21/2014 02:47:49 PM Eastern Daylight Time		05/27/2014 05:04:07 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	108	0	2015	State of Louisiana		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	109	0		29	10	S5884_109_0	1		1	05/21/2014	2015.02	05/21/2014 02:48:10 PM Eastern Daylight Time		05/27/2014 05:04:08 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	109	0	2015	State of Kansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	110	0		29	10	S5884_110_0	1		1	05/21/2014	2015.02	05/21/2014 02:48:27 PM Eastern Daylight Time		05/27/2014 05:04:08 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	110	0	2015	State of New Mexico		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	111	0		29	10	S5884_111_0	1		1	05/21/2014	2015.02	05/21/2014 02:48:44 PM Eastern Daylight Time		05/27/2014 05:04:09 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	111	0	2015	State of Colorado		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	112	0		29	10	S5884_112_0	1		1	05/21/2014	2015.02	05/21/2014 02:48:59 PM Eastern Daylight Time		05/27/2014 05:04:09 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	112	0	2015	State of Nevada		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	113	0		29	10	S5884_113_0	1		1	05/21/2014	2015.02	05/21/2014 02:49:16 PM Eastern Daylight Time		05/27/2014 05:04:09 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	113	0	2015	States of Oregon and Washington		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	114	0		29	10	S5884_114_0	1		1	05/24/2014	2015.02	05/24/2014 01:12:48 PM Eastern Daylight Time		05/27/2014 05:04:10 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	114	0	2015	State of California		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	115	0		29	10	S5884_115_0	1		1	05/21/2014	2015.02	05/21/2014 02:49:50 PM Eastern Daylight Time		05/27/2014 05:04:10 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	115	0	2015	State of Hawaii		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	116	0		29	10	S5884_116_0	1		1	05/21/2014	2015.02	05/21/2014 02:50:08 PM Eastern Daylight Time		05/27/2014 05:04:12 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	116	0	2015	State of Alaska		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	131	0		29	10	S5884_131_0	1		1	05/21/2014	2015.02	05/21/2014 02:50:28 PM Eastern Daylight Time		05/27/2014 05:04:13 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	131	0	2015	State of New Jersey		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	132	0		29	10	S5884_132_0	1		1	05/21/2014	2015.02	05/21/2014 02:50:44 PM Eastern Daylight Time		05/27/2014 05:04:13 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	132	0	2015	State of Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	133	0		29	10	S5884_133_0	1		1	05/21/2014	2015.02	05/21/2014 02:51:00 PM Eastern Daylight Time		05/27/2014 05:04:13 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	133	0	2015	State of North Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	134	0		29	10	S5884_134_0	1		1	05/21/2014	2015.02	05/21/2014 02:51:17 PM Eastern Daylight Time		05/27/2014 05:04:14 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	134	0	2015	State of South Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	135	0		29	10	S5884_135_0	1		1	05/21/2014	2015.02	05/21/2014 02:51:59 PM Eastern Daylight Time		05/27/2014 05:04:14 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	135	0	2015	State of Georgia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	136	0		29	10	S5884_136_0	1		1	05/21/2014	2015.02	05/21/2014 02:52:31 PM Eastern Daylight Time		05/27/2014 05:04:15 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	136	0	2015	State of Michigan		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	137	0		29	10	S5884_137_0	1		1	05/21/2014	2015.02	05/21/2014 02:52:54 PM Eastern Daylight Time		05/27/2014 05:04:15 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	137	0	2015	State of Ohio		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	138	0		29	10	S5884_138_0	1		1	05/21/2014	2015.02	05/21/2014 02:53:19 PM Eastern Daylight Time		05/27/2014 05:04:15 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	138	0	2015	States of Indiana and Kentucky		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	139	0		29	10	S5884_139_0	1		1	05/21/2014	2015.02	05/21/2014 02:53:37 PM Eastern Daylight Time		05/27/2014 05:04:16 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	139	0	2015	State of Wisconsin		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	140	0		29	10	S5884_140_0	1		1	05/21/2014	2015.02	05/21/2014 02:53:54 PM Eastern Daylight Time		05/27/2014 05:04:16 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	140	0	2015	State of Missouri		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	141	0		29	10	S5884_141_0	1		1	05/24/2014	2015.02	05/24/2014 01:11:41 PM Eastern Daylight Time		05/27/2014 05:04:17 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	141	0	2015	State of Arkansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	142	0		29	10	S5884_142_0	1		1	05/21/2014	2015.02	05/21/2014 02:54:25 PM Eastern Daylight Time		05/27/2014 05:04:17 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	142	0	2015	State of Mississippi		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	143	0		29	10	S5884_143_0	1		1	05/21/2014	2015.02	05/21/2014 02:54:43 PM Eastern Daylight Time		05/27/2014 05:04:17 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	143	0	2015	State of Texas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	144	0		29	10	S5884_144_0	1		1	05/21/2014	2015.02	05/21/2014 02:55:03 PM Eastern Daylight Time		05/27/2014 05:04:18 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	144	0	2015	State of Oklahoma		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	145	0		29	10	S5884_145_0	1		1	05/21/2014	2015.02	05/21/2014 02:55:21 PM Eastern Daylight Time		05/27/2014 05:04:18 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	145	0	2015	States of IA, MN, MT, ND, NE, SD, WY		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	146	0		29	10	S5884_146_0	1		1	05/21/2014	2015.02	05/21/2014 02:55:37 PM Eastern Daylight Time		05/27/2014 05:04:18 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	146	0	2015	State of Arizona		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	147	0		29	10	S5884_147_0	1		1	05/21/2014	2015.02	05/21/2014 02:55:54 PM Eastern Daylight Time		05/27/2014 05:04:19 PM Eastern Daylight Time			05/28/2014 02:39:02 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Preferred Rx Plan (PDP)	10	29					S5884	147	0	2015	States of Idaho and Utah		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	148	0		29	10	S5884_148_0	2		1	07/21/2014	2015.02	07/21/2014 12:58:30 PM Eastern Daylight Time		07/22/2014 06:34:12 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	148	0	2015	States of New Hampshire and Maine		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	149	0		29	10	S5884_149_0	2		1	07/21/2014	2015.02	07/21/2014 01:01:33 PM Eastern Daylight Time		07/22/2014 06:34:12 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	149	0	2015	States of CT, MA, RI, VT		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	150	0		29	10	S5884_150_0	2		1	07/21/2014	2015.02	07/21/2014 01:03:01 PM Eastern Daylight Time		07/22/2014 06:34:13 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	150	0	2015	State of New Jersey		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	151	0		29	10	S5884_151_0	2		1	07/21/2014	2015.02	07/21/2014 01:04:08 PM Eastern Daylight Time		07/22/2014 06:34:13 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	151	0	2015	States of DC, DE, MD		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	152	0		29	10	S5884_152_0	2		1	07/21/2014	2015.02	07/21/2014 01:04:57 PM Eastern Daylight Time		07/22/2014 06:34:13 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	152	0	2015	States of Pennsylvania and West Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	153	0		29	10	S5884_153_0	2		1	07/21/2014	2015.02	07/21/2014 01:05:59 PM Eastern Daylight Time		07/22/2014 06:34:13 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	153	0	2015	State of Virginia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	154	0		29	10	S5884_154_0	2		1	07/21/2014	2015.02	07/21/2014 01:07:02 PM Eastern Daylight Time		07/22/2014 06:34:13 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	154	0	2015	State of North Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	155	0		29	10	S5884_155_0	2		1	07/21/2014	2015.02	07/21/2014 01:08:01 PM Eastern Daylight Time		07/22/2014 06:34:13 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	155	0	2015	State of South Carolina		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	156	0		29	10	S5884_156_0	2		1	07/21/2014	2015.02	07/21/2014 01:08:50 PM Eastern Daylight Time		07/22/2014 06:34:14 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	156	0	2015	State of Georgia		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	157	0		29	10	S5884_157_0	2		1	07/21/2014	2015.02	07/21/2014 01:09:54 PM Eastern Daylight Time		07/22/2014 06:34:14 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	157	0	2015	State of Florida		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	158	0		29	10	S5884_158_0	2		1	07/21/2014	2015.02	07/21/2014 01:10:47 PM Eastern Daylight Time		07/22/2014 06:34:14 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	158	0	2015	States of Alabama and Tennessee		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	159	0		29	10	S5884_159_0	2		1	07/21/2014	2015.02	07/21/2014 01:13:01 PM Eastern Daylight Time		07/22/2014 06:34:14 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	159	0	2015	State of Michigan		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	160	0		29	10	S5884_160_0	2		1	07/21/2014	2015.02	07/21/2014 01:14:03 PM Eastern Daylight Time		07/22/2014 06:34:14 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	160	0	2015	State of Ohio		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	161	0		29	10	S5884_161_0	2		1	07/21/2014	2015.02	07/21/2014 01:14:56 PM Eastern Daylight Time		07/22/2014 06:34:15 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	161	0	2015	States of Indiana and Kentucky		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	162	0		29	10	S5884_162_0	2		1	07/21/2014	2015.02	07/21/2014 01:15:34 PM Eastern Daylight Time		07/22/2014 06:34:15 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	162	0	2015	State of Wisconsin		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	163	0		29	10	S5884_163_0	2		1	07/21/2014	2015.02	07/21/2014 01:16:09 PM Eastern Daylight Time		07/22/2014 06:34:15 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	163	0	2015	State of Illinois		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	164	0		29	10	S5884_164_0	2		1	07/21/2014	2015.02	07/21/2014 01:16:47 PM Eastern Daylight Time		07/22/2014 06:34:15 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	164	0	2015	State of Missouri		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	165	0		29	10	S5884_165_0	2		1	07/22/2014	2015.02	07/22/2014 01:34:33 PM Eastern Daylight Time		07/22/2014 06:34:15 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	165	0	2015	State of Arkansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	166	0		29	10	S5884_166_0	2		1	07/21/2014	2015.02	07/21/2014 01:18:08 PM Eastern Daylight Time		07/22/2014 06:34:16 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	166	0	2015	State of Mississippi		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	167	0		29	10	S5884_167_0	2		1	07/21/2014	2015.02	07/21/2014 01:19:02 PM Eastern Daylight Time		07/22/2014 06:34:16 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	167	0	2015	State of Louisiana		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	168	0		29	10	S5884_168_0	2		1	07/21/2014	2015.02	07/21/2014 01:19:48 PM Eastern Daylight Time		07/22/2014 06:34:16 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	168	0	2015	State of Texas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	169	0		29	10	S5884_169_0	2		1	07/21/2014	2015.02	07/21/2014 01:20:55 PM Eastern Daylight Time		07/22/2014 06:34:16 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	169	0	2015	State of Oklahoma		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	170	0		29	10	S5884_170_0	2		1	07/21/2014	2015.02	07/21/2014 01:21:39 PM Eastern Daylight Time		07/22/2014 06:34:16 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	170	0	2015	State of Kansas		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	171	0		29	10	S5884_171_0	2		1	07/21/2014	2015.02	07/21/2014 01:22:25 PM Eastern Daylight Time		07/22/2014 06:34:16 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	171	0	2015	States of IA, MN, MT, ND, NE, SD, WY		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	172	0		29	10	S5884_172_0	2		1	07/21/2014	2015.02	07/21/2014 01:23:02 PM Eastern Daylight Time		07/22/2014 06:34:17 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	172	0	2015	State of New Mexico		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	173	0		29	10	S5884_173_0	2		1	07/21/2014	2015.02	07/21/2014 01:23:40 PM Eastern Daylight Time		07/22/2014 06:34:17 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	173	0	2015	State of Colorado		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	174	0		29	10	S5884_174_0	2		1	07/21/2014	2015.02	07/21/2014 01:24:30 PM Eastern Daylight Time		07/22/2014 06:34:17 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	174	0	2015	State of Arizona		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	175	0		29	10	S5884_175_0	2		1	07/21/2014	2015.02	07/21/2014 01:25:47 PM Eastern Daylight Time		07/22/2014 06:34:05 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	175	0	2015	State of Nevada		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	176	0		29	10	S5884_176_0	2		1	07/21/2014	2015.02	07/21/2014 01:26:21 PM Eastern Daylight Time		07/22/2014 06:34:05 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	176	0	2015	States of Oregon and Washington		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	177	0		29	10	S5884_177_0	2		1	07/21/2014	2015.02	07/21/2014 01:27:06 PM Eastern Daylight Time		07/22/2014 06:34:05 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	177	0	2015	States of Idaho and Utah		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	178	0		29	10	S5884_178_0	2		1	07/21/2014	2015.02	07/21/2014 01:27:38 PM Eastern Daylight Time		07/22/2014 06:34:05 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	178	0	2015	State of California		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	179	0		29	10	S5884_179_0	2		1	07/22/2014	2015.02	07/22/2014 01:35:06 PM Eastern Daylight Time		07/22/2014 06:34:05 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	179	0	2015	State of Hawaii		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	180	0		29	10	S5884_180_0	2		1	07/21/2014	2015.02	07/21/2014 01:28:49 PM Eastern Daylight Time		07/22/2014 06:34:05 PM Eastern Daylight Time			07/22/2014 07:57:31 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Walmart Rx Plan (PDP)	10	29					S5884	180	0	2015	State of Alaska		2					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	834	0		29	10	S5884_834_0	1		1	05/27/2014	2015.02	05/27/2014 01:33:44 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer (PDP)	10	29					S5884	834	0	2015	All Regions		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	835	0		29	10	S5884_835_0	1		1	05/27/2014	2015.02	05/27/2014 01:34:43 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer Non-CY (PDP)	10	29					S5884	835	0	2015	All Regions		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5884	836	0		29	10	S5884_836_0	1		1	05/27/2014	2015.02	05/27/2014 01:34:01 PM Eastern Daylight Time					05/28/2014 04:25:56 PM Eastern Daylight Time	HUMANA INSURANCE COMPANY	Humana Insurance Company	www.humana-medicare.com	Humana Medicare Employer - Walmart (PDP)	10	29					S5884	836	0	2015	All Regions		1					2								www.humana.com/medicare/medicare_prescription_drugs/medicare_drug_tools/medicare_drug_list/	www.humana.com/Medicare/medicare_prescription_drugs									(800)281-6918		(800)281-6918		(800)706-0872		(800)706-0872										(711)-		(711)-		(711)-		(711)-												
S5904	001	0		29	10	S5904_001_0	3		1	05/30/2014	2015.01	05/30/2014 11:01:10 AM Eastern Daylight Time		06/01/2014 07:33:29 AM Eastern Daylight Time			06/01/2014 09:47:48 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Rx-Option 1 (PDP)	10	29					S5904	001	0	2015	State of Florida		2					2								MyPrime.com	www.BlueMedicareFL.com									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770												
S5904	002	0		29	10	S5904_002_0	3		1	05/30/2014	2015.01	05/30/2014 11:01:25 AM Eastern Daylight Time		06/01/2014 07:36:18 AM Eastern Daylight Time			06/01/2014 09:47:48 PM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Rx-Option 2 (PDP)	10	29					S5904	002	0	2015	State of Florida		2					2								MyPrime.com	www.BlueMedicareFL.com									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770												
S5904	801	0		29	10	S5904_801_0	1		1	05/23/2014	2015.01	05/23/2014 01:15:50 PM Eastern Daylight Time					05/30/2014 11:29:51 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group Rx (PDP)	10	29					S5904	801	0	2015	State of Florida with National Coverage		1					2								MyPrime.com	www.BlueMedicareFL.com									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770												
S5904	802	0		29	10	S5904_802_0	1		1	05/23/2014	2015.01	05/23/2014 01:16:06 PM Eastern Daylight Time					05/30/2014 11:29:51 AM Eastern Daylight Time	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Florida Blue	BlueMedicareFL.com	BlueMedicare Group Rx (PDP)	10	29					S5904	802	0	2015	State of Florida with National Coverage		1					2								MyPrime.com	www.BlueMedicareFL.com									(800)926-6565		(800)926-6565		(855)601-9465		(855)601-9465										(800)955-8770		(800)955-8770		(800)955-8770		(800)955-8770												
S5916	001	0		29	10	S5916_001_0	5		1	05/29/2014	2015.01	05/29/2014 09:05:28 PM Mountain Daylight Time		05/30/2014 08:34:36 AM Pacific Daylight Time			06/02/2014 04:50:01 PM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script Basic (PDP)	10	29					S5916	001	0	2015	Region of Idaho and Utah		2					2								www.regence.com/medicare	www.regence.com/medicare									(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-												
S5916	002	0		29	10	S5916_002_0	5		1	05/16/2014	2015.01	05/16/2014 12:12:18 PM Mountain Daylight Time		05/30/2014 08:35:01 AM Pacific Daylight Time			06/02/2014 04:50:01 PM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script Enhanced (PDP)	10	29					S5916	002	0	2015	Region of Idaho and Utah		2					2								www.regence.com/medicare	www.regence.com/medicare									(800)541-8981		(800)541-8981		(888)369-3171		(888)369-3171										(711)-		(711)-		(711)-		(711)-												
S5916	802	0		29	10	S5916_802_0	5		1	04/25/2014	2015.01	04/25/2014 02:51:12 PM Mountain Daylight Time					06/02/2014 04:50:01 PM Pacific Daylight Time	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	Regence BlueShield of Idaho and Regence BC BS Utah	www.regence.com/medicare	Regence Medicare Script (PDP)	10	29					S5916	802	0	2015	Nationwide except territories		1					2								www.regence.com/medicare	www.regence.com/medicare									(888)319-8904		(888)319-8904		(888)319-8904		(888)319-8904										(711)-		(711)-		(711)-		(711)-												
S5921	348	0		29	10	S5921_348_0	1		1	05/28/2014	2015.02	05/28/2014 10:54:29 AM Central Daylight Time		05/30/2014 02:41:20 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	348	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	349	0		29	10	S5921_349_0	1		1	05/29/2014	2015.02	05/29/2014 10:13:47 AM Central Daylight Time		05/30/2014 02:41:24 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	349	0	2015	New Jersey		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	350	0		29	10	S5921_350_0	1		1	05/28/2014	2015.02	05/28/2014 01:39:14 PM Central Daylight Time		05/30/2014 02:41:27 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	350	0	2015	Delaware, Maryland and Washington D.C.		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	351	0		29	10	S5921_351_0	1		1	05/27/2014	2015.02	05/27/2014 06:54:33 PM Central Daylight Time		05/30/2014 02:41:31 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	351	0	2015	Pennsylvania and West Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	352	0		29	10	S5921_352_0	1		1	05/27/2014	2015.02	05/27/2014 06:58:45 PM Central Daylight Time		05/30/2014 02:41:35 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	352	0	2015	Virginia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	353	0		29	10	S5921_353_0	1		1	05/27/2014	2015.02	05/27/2014 07:02:22 PM Central Daylight Time		05/30/2014 02:41:39 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	353	0	2015	North Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	354	0		29	10	S5921_354_0	1		1	05/27/2014	2015.02	05/27/2014 09:04:42 PM Central Daylight Time		05/30/2014 02:41:43 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	354	0	2015	South Carolina		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	355	0		29	10	S5921_355_0	1		1	05/27/2014	2015.02	05/27/2014 07:06:34 PM Central Daylight Time		05/30/2014 02:41:47 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	355	0	2015	Georgia		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	356	0		29	10	S5921_356_0	1		1	05/27/2014	2015.02	05/27/2014 10:22:49 PM Central Daylight Time		05/30/2014 02:44:11 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	356	0	2015	Florida		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	357	0		29	10	S5921_357_0	1		1	05/28/2014	2015.02	05/28/2014 02:48:47 PM Central Daylight Time		05/30/2014 02:44:15 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	357	0	2015	Alabama and Tennessee		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	358	0		29	10	S5921_358_0	1		1	05/28/2014	2015.02	05/28/2014 02:48:16 PM Central Daylight Time		05/30/2014 02:44:18 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	358	0	2015	Michigan		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	359	0		29	10	S5921_359_0	1		1	05/27/2014	2015.02	05/27/2014 10:25:52 PM Central Daylight Time		05/30/2014 02:44:22 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	359	0	2015	Ohio		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	360	0		29	10	S5921_360_0	1		1	05/27/2014	2015.02	05/27/2014 08:38:58 PM Central Daylight Time		05/30/2014 02:44:26 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	360	0	2015	Indiana and Kentucky		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	361	0		29	10	S5921_361_0	1		1	05/27/2014	2015.02	05/27/2014 10:28:21 PM Central Daylight Time		05/30/2014 02:44:30 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	361	0	2015	Wisconsin		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	362	0		29	10	S5921_362_0	1		1	05/27/2014	2015.02	05/27/2014 11:51:44 PM Central Daylight Time		05/30/2014 02:44:34 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	362	0	2015	Illinois		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	363	0		29	10	S5921_363_0	1		1	05/29/2014	2015.02	05/29/2014 08:26:54 AM Central Daylight Time		05/30/2014 02:44:38 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	363	0	2015	Missouri		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	364	0		29	10	S5921_364_0	1		1	05/27/2014	2015.02	05/27/2014 08:46:58 PM Central Daylight Time		05/30/2014 02:44:42 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	364	0	2015	Arkansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	365	0		29	10	S5921_365_0	1		1	05/27/2014	2015.02	05/27/2014 09:08:29 PM Central Daylight Time		05/30/2014 02:44:45 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	365	0	2015	Mississippi		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	366	0		29	10	S5921_366_0	1		1	05/27/2014	2015.02	05/27/2014 09:11:47 PM Central Daylight Time		05/30/2014 02:44:49 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	366	0	2015	Louisiana		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	367	0		29	10	S5921_367_0	1		1	05/27/2014	2015.02	05/27/2014 10:32:28 PM Central Daylight Time		05/30/2014 02:44:53 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	367	0	2015	Texas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	368	0		29	10	S5921_368_0	1		1	05/27/2014	2015.02	05/27/2014 09:15:29 PM Central Daylight Time		05/30/2014 02:44:57 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	368	0	2015	Oklahoma		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	369	0		29	10	S5921_369_0	1		1	05/27/2014	2015.02	05/27/2014 10:36:07 PM Central Daylight Time		05/30/2014 02:45:01 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	369	0	2015	Kansas		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	370	0		29	10	S5921_370_0	1		1	05/27/2014	2015.02	05/27/2014 09:18:06 PM Central Daylight Time		05/30/2014 02:45:05 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	370	0	2015	IA, MN, MT, ND, NE, SD, WY		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	371	0		29	10	S5921_371_0	1		1	05/27/2014	2015.02	05/27/2014 08:49:07 PM Central Daylight Time		05/30/2014 02:45:08 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	371	0	2015	New Mexico		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	372	0		29	10	S5921_372_0	1		1	05/27/2014	2015.02	05/27/2014 09:23:13 PM Central Daylight Time		05/30/2014 02:45:12 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	372	0	2015	Colorado		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	373	0		29	10	S5921_373_0	1		1	05/27/2014	2015.02	05/27/2014 08:53:46 PM Central Daylight Time		05/30/2014 02:45:16 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	373	0	2015	Nevada		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	374	0		29	10	S5921_374_0	1		1	05/27/2014	2015.02	05/27/2014 09:25:16 PM Central Daylight Time		05/30/2014 02:45:20 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	374	0	2015	Oregon and Washington		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	375	0		29	10	S5921_375_0	1		1	05/28/2014	2015.02	05/28/2014 02:53:08 PM Central Daylight Time		05/30/2014 02:45:24 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	375	0	2015	Idaho and Utah		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	376	0		29	10	S5921_376_0	1		1	05/27/2014	2015.02	05/27/2014 08:55:46 PM Central Daylight Time		05/30/2014 02:45:28 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	376	0	2015	California		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	377	0		29	10	S5921_377_0	1		1	05/27/2014	2015.02	05/27/2014 09:33:15 PM Central Daylight Time		05/30/2014 02:45:32 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	377	0	2015	Alaska		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	378	0		29	10	S5921_378_0	1		1	05/27/2014	2015.02	05/27/2014 06:15:35 PM Central Daylight Time		05/30/2014 02:45:37 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	378	0	2015	Maine and New Hampshire		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	379	0		29	10	S5921_379_0	1		1	05/28/2014	2015.02	05/28/2014 02:54:11 PM Central Daylight Time		05/30/2014 02:45:43 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	379	0	2015	New York		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	380	0		29	10	S5921_380_0	1		1	05/27/2014	2015.02	05/27/2014 08:52:04 PM Central Daylight Time		05/30/2014 02:45:48 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	380	0	2015	Arizona		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	381	0		29	10	S5921_381_0	1		1	05/27/2014	2015.02	05/27/2014 09:29:40 PM Central Daylight Time		05/30/2014 02:45:53 PM Central Daylight Time			05/30/2014 04:02:51 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.AARPMedicareRx.com	AARP MedicareRx Saver Plus (PDP)	10	29					S5921	381	0	2015	Hawaii		2					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)867-5575		(888)867-5575		(866)679-3282		(866)679-3282										(711)-		(711)-		(711)-		(711)-												
S5921	802	0		29	10	S5921_802_0	1		1	04/18/2014	2015.02	04/18/2014 10:53:07 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	802	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5921	837	0		29	10	S5921_837_0	1		1	04/18/2014	2015.02	04/18/2014 10:53:10 AM Central Daylight Time					05/31/2014 12:54:57 PM Central Daylight Time	UNITEDHEALTHCARE INS. CO. AND UNITEDHEALTHCARE NY	UnitedHealthcare	www.unitedhealthrxforgroups.com	UnitedHealthcare MedicareRx for Groups (PDP)	10	29					S5921	837	0	2015	National		1					2								www.AARPMedicareRx.com	www.AARPMedicareRx.com									(888)556-6648		(888)556-6648		(877)558-4749		(877)558-4749										(711)-		(711)-		(711)-		(711)-												
S5953	001	0		29	10	S5953_001_0	4		1	05/31/2014	2015.01	05/31/2014 04:46:00 PM Eastern Daylight Time		07/16/2014 11:19:56 AM Eastern Daylight Time			07/17/2014 01:26:48 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/rx15	MedBlue Rx (PDP)	10	29					S5953	001	0	2015	South Carolina		2					2								www.scbluesmedadvantage.com/marx15	www.scbluesmedadvantage.com/marx15									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219												
S5953	002	0		29	10	S5953_002_0	5		1	05/12/2014	2015.01	05/12/2014 02:25:51 PM Eastern Daylight Time		07/16/2014 11:20:10 AM Eastern Daylight Time			07/17/2014 01:26:48 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/rxplus15	MedBlue Rx Plus (PDP)	10	29					S5953	002	0	2015	South Carolina		2					2								www.scbluesmedadvantage.com/marx15	www.scbluesmedadvantage.com/marx15									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219												
S5953	801	0		29	10	S5953_801_0	1		1	05/31/2014	2015.01	05/31/2014 04:41:00 PM Eastern Daylight Time					06/01/2014 03:50:55 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx15	Group Blue Rx Plus (PDP)	10	29					S5953	801	0	2015	South Carolina		1					2								www.scbluesmedadvantage.com/marx15	www.scbluesmedadvantage.com/marx15									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219												
S5953	802	0		29	10	S5953_802_0	1		1	05/31/2014	2015.01	05/31/2014 04:41:24 PM Eastern Daylight Time					06/01/2014 03:50:55 PM Eastern Daylight Time	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Blue Cross Blue Shield of South Carolina	www.scbluesmedadvantage.com/marx15	Group Blue Rx Plus (PDP)	10	29					S5953	802	0	2015	South Carolina		1					2								www.scbluesmedadvantage.com/marx15	www.scbluesmedadvantage.com/marx15									(888)645-6025		(888)645-6025		(800)930-2836		(800)930-2836										(888)645-6023		(888)645-6023		(888)899-4219		(888)899-4219												
S5960	801	0		29	10	S5960_801_0	1		1	05/29/2014	2015.01	05/29/2014 04:23:16 PM Pacific Daylight Time					05/30/2014 09:27:29 AM Pacific Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	www.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	801	0	2015	All States (Nationwide)		1					2								www.unicare.com/medicare	www.unicare.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-												
S5960	803	0		29	10	S5960_803_0	1		1	05/29/2014	2015.01	05/29/2014 04:23:20 PM Pacific Daylight Time					05/30/2014 09:27:29 AM Pacific Daylight Time	UNICARE LIFE & HEALTH INSURANCE COMPANY	UniCare	www.unicare.com/medicare	MedicareRx Rewards (PDP)	10	29					S5960	803	0	2015	All States (Nationwide)		1					2								www.unicare.com/medicare	www.unicare.com/medicare									(866)470-6265		(866)470-6265		(866)646-2436		(866)646-2436										(711)-		(711)-		(711)-		(711)-												
S5966	803	0		29	10	S5966_803_0	1		1	05/30/2014	2015.01	05/30/2014 04:12:36 PM Eastern Daylight Time					05/30/2014 04:16:20 PM Eastern Daylight Time	GROUP HEALTH INCORPORATED	EmblemHealth Medicare PDP	www.emblemhealth.com	EmblemHealth National Drug Plan (PDP)	10	29					S5966	803	0	2015	United States		1					2								www.emblemhealth.com	www.emblemhealth.com									(877)444-7241		(877)444-7241		(800)447-9169		(800)447-9169										(711)-		(711)-		(711)-		(711)-												
S5967	138	0		29	10	S5967_138_0	4		1	05/29/2014	2015.02	05/29/2014 04:35:26 PM Eastern Daylight Time		06/02/2014 02:00:58 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	138	0	2015	Northern New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	139	0		29	10	S5967_139_0	4		1	05/29/2014	2015.02	05/29/2014 01:47:04 PM Eastern Daylight Time		06/02/2014 02:01:09 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	139	0	2015	Central New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	140	0		29	10	S5967_140_0	4		1	05/29/2014	2015.02	05/29/2014 01:49:35 PM Eastern Daylight Time		06/02/2014 02:01:19 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	140	0	2015	New York		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	141	0		29	10	S5967_141_0	4		1	05/29/2014	2015.02	05/29/2014 01:51:17 PM Eastern Daylight Time		06/02/2014 02:01:30 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	141	0	2015	New Jersey		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	142	0		29	10	S5967_142_0	4		1	05/29/2014	2015.02	05/29/2014 01:51:58 PM Eastern Daylight Time		06/02/2014 02:01:40 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	142	0	2015	Mid-Atlantic		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	143	0		29	10	S5967_143_0	4		1	05/29/2014	2015.02	05/29/2014 01:53:50 PM Eastern Daylight Time		06/02/2014 02:01:51 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	143	0	2015	Pennsylvania, West Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	144	0		29	10	S5967_144_0	4		1	05/29/2014	2015.02	05/29/2014 01:54:47 PM Eastern Daylight Time		06/02/2014 02:02:02 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	144	0	2015	Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	145	0		29	10	S5967_145_0	4		1	05/29/2014	2015.02	05/29/2014 01:55:38 PM Eastern Daylight Time		06/02/2014 02:02:13 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	145	0	2015	North Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	146	0		29	10	S5967_146_0	4		1	05/29/2014	2015.02	05/29/2014 01:56:10 PM Eastern Daylight Time		06/02/2014 02:02:24 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	146	0	2015	South Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	147	0		29	10	S5967_147_0	4		1	05/29/2014	2015.02	05/29/2014 01:56:48 PM Eastern Daylight Time		06/02/2014 02:02:34 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	147	0	2015	Georgia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	148	0		29	10	S5967_148_0	4		1	05/29/2014	2015.02	05/29/2014 01:58:06 PM Eastern Daylight Time		06/02/2014 02:02:45 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	148	0	2015	Florida		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	149	0		29	10	S5967_149_0	4		1	05/29/2014	2015.02	05/29/2014 01:59:47 PM Eastern Daylight Time		06/02/2014 02:02:56 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	149	0	2015	Alabama, Tennessee		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	150	0		29	10	S5967_150_0	4		1	05/29/2014	2015.02	05/29/2014 02:00:17 PM Eastern Daylight Time		06/02/2014 02:03:06 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	150	0	2015	Michigan		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	151	0		29	10	S5967_151_0	4		1	05/29/2014	2015.02	05/29/2014 02:01:11 PM Eastern Daylight Time		06/02/2014 02:03:17 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	151	0	2015	Ohio		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	152	0		29	10	S5967_152_0	4		1	05/29/2014	2015.02	05/29/2014 02:06:00 PM Eastern Daylight Time		06/02/2014 02:03:28 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	152	0	2015	Indiana, Kentucky		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	154	0		29	10	S5967_154_0	4		1	05/29/2014	2015.02	05/29/2014 02:08:05 PM Eastern Daylight Time		06/02/2014 02:03:38 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	154	0	2015	Illinois		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	155	0		29	10	S5967_155_0	4		1	05/29/2014	2015.02	05/29/2014 02:09:41 PM Eastern Daylight Time		06/02/2014 02:03:49 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	155	0	2015	Missouri		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	156	0		29	10	S5967_156_0	4		1	05/29/2014	2015.02	05/29/2014 02:11:39 PM Eastern Daylight Time		06/02/2014 02:03:59 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	156	0	2015	Arkansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	157	0		29	10	S5967_157_0	4		1	05/29/2014	2015.02	05/29/2014 02:12:59 PM Eastern Daylight Time		06/02/2014 02:04:10 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	157	0	2015	Mississippi		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	158	0		29	10	S5967_158_0	4		1	05/29/2014	2015.02	05/29/2014 02:14:25 PM Eastern Daylight Time		06/02/2014 02:04:20 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	158	0	2015	Louisiana		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	159	0		29	10	S5967_159_0	4		1	05/30/2014	2015.02	05/30/2014 01:11:58 PM Eastern Daylight Time		06/02/2014 02:04:31 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	159	0	2015	Texas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	160	0		29	10	S5967_160_0	4		1	05/29/2014	2015.02	05/29/2014 02:17:09 PM Eastern Daylight Time		06/02/2014 02:04:41 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	160	0	2015	Oklahoma		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	161	0		29	10	S5967_161_0	4		1	05/29/2014	2015.02	05/29/2014 02:21:09 PM Eastern Daylight Time		06/02/2014 02:04:51 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	161	0	2015	Kansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	162	0		29	10	S5967_162_0	4		1	05/30/2014	2015.02	05/30/2014 01:13:58 PM Eastern Daylight Time		06/02/2014 02:05:01 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	162	0	2015	Upper Midwest and Northern Plains		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	163	0		29	10	S5967_163_0	4		1	05/29/2014	2015.02	05/29/2014 02:23:43 PM Eastern Daylight Time		06/02/2014 02:05:12 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	163	0	2015	New Mexico		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	164	0		29	10	S5967_164_0	4		1	05/29/2014	2015.02	05/29/2014 02:24:53 PM Eastern Daylight Time		06/02/2014 02:05:23 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	164	0	2015	Colorado		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	165	0		29	10	S5967_165_0	4		1	05/29/2014	2015.02	05/29/2014 02:26:06 PM Eastern Daylight Time		06/02/2014 02:05:33 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	165	0	2015	Arizona		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	166	0		29	10	S5967_166_0	4		1	05/29/2014	2015.02	05/29/2014 02:27:01 PM Eastern Daylight Time		06/02/2014 02:05:44 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	166	0	2015	Nevada		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	167	0		29	10	S5967_167_0	4		1	05/29/2014	2015.02	05/29/2014 02:27:36 PM Eastern Daylight Time		06/02/2014 02:05:54 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	167	0	2015	Oregon, Washington		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	168	0		29	10	S5967_168_0	4		1	05/29/2014	2015.02	05/29/2014 02:28:33 PM Eastern Daylight Time		06/02/2014 02:06:05 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	168	0	2015	Idaho, Utah		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	169	0		29	10	S5967_169_0	4		1	05/29/2014	2015.02	05/29/2014 02:32:28 PM Eastern Daylight Time		06/02/2014 02:06:15 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	169	0	2015	California		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	170	0		29	10	S5967_170_0	4		1	05/29/2014	2015.02	05/29/2014 02:33:34 PM Eastern Daylight Time		06/02/2014 02:06:26 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	170	0	2015	Hawaii		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	171	0		29	10	S5967_171_0	4		1	05/31/2014	2015.02	05/31/2014 10:41:49 AM Eastern Daylight Time		06/02/2014 02:06:37 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Classic (PDP)	10	29					S5967	171	0	2015	Alaska		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	173	0		29	10	S5967_173_0	4		1	05/29/2014	2015.02	05/29/2014 04:36:21 PM Eastern Daylight Time		06/02/2014 02:19:08 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	173	0	2015	Northern New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	174	0		29	10	S5967_174_0	4		1	05/29/2014	2015.02	05/29/2014 04:37:02 PM Eastern Daylight Time		06/02/2014 02:19:19 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	174	0	2015	Central New England		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	175	0		29	10	S5967_175_0	4		1	05/29/2014	2015.02	05/29/2014 04:41:41 PM Eastern Daylight Time		06/02/2014 02:19:29 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	175	0	2015	New York		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	176	0		29	10	S5967_176_0	4		1	05/29/2014	2015.02	05/29/2014 04:42:00 PM Eastern Daylight Time		06/02/2014 02:19:40 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	176	0	2015	New Jersey		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	177	0		29	10	S5967_177_0	4		1	05/29/2014	2015.02	05/29/2014 04:42:19 PM Eastern Daylight Time		06/02/2014 02:19:51 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	177	0	2015	Mid-Atlantic		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	178	0		29	10	S5967_178_0	4		1	05/29/2014	2015.02	05/29/2014 04:45:35 PM Eastern Daylight Time		06/02/2014 02:20:02 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	178	0	2015	Pennsylvania, West Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	179	0		29	10	S5967_179_0	5		1	06/27/2014	2015.02	06/27/2014 04:04:59 PM Eastern Daylight Time		07/01/2014 10:44:40 AM Eastern Daylight Time			07/03/2014 11:22:20 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	179	0	2015	Virginia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	180	0		29	10	S5967_180_0	4		1	05/29/2014	2015.02	05/29/2014 04:46:12 PM Eastern Daylight Time		06/02/2014 02:20:24 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	180	0	2015	North Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	181	0		29	10	S5967_181_0	5		1	06/27/2014	2015.02	06/27/2014 04:05:37 PM Eastern Daylight Time		07/01/2014 10:45:13 AM Eastern Daylight Time			07/03/2014 11:22:20 AM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	181	0	2015	South Carolina		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	182	0		29	10	S5967_182_0	4		1	05/29/2014	2015.02	05/29/2014 04:46:50 PM Eastern Daylight Time		06/02/2014 02:20:45 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	182	0	2015	Georgia		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	183	0		29	10	S5967_183_0	4		1	05/29/2014	2015.02	05/29/2014 04:47:50 PM Eastern Daylight Time		06/02/2014 02:20:56 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	183	0	2015	Florida		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	184	0		29	10	S5967_184_0	4		1	05/29/2014	2015.02	05/29/2014 04:48:10 PM Eastern Daylight Time		06/02/2014 02:21:06 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	184	0	2015	Alabama, Tennessee		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	185	0		29	10	S5967_185_0	4		1	05/29/2014	2015.02	05/29/2014 04:48:32 PM Eastern Daylight Time		06/02/2014 02:21:17 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	185	0	2015	Michigan		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	186	0		29	10	S5967_186_0	4		1	05/29/2014	2015.02	05/29/2014 04:48:52 PM Eastern Daylight Time		06/02/2014 02:21:27 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	186	0	2015	Ohio		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	187	0		29	10	S5967_187_0	4		1	05/29/2014	2015.02	05/29/2014 04:49:10 PM Eastern Daylight Time		06/02/2014 02:21:38 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	187	0	2015	Indiana, Kentucky		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	188	0		29	10	S5967_188_0	4		1	05/29/2014	2015.02	05/29/2014 04:49:28 PM Eastern Daylight Time		06/02/2014 02:21:49 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	188	0	2015	Illinois		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	189	0		29	10	S5967_189_0	4		1	05/29/2014	2015.02	05/29/2014 04:50:34 PM Eastern Daylight Time		06/02/2014 02:22:00 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	189	0	2015	Missouri		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	190	0		29	10	S5967_190_0	5		1	06/27/2014	2015.02	06/27/2014 04:06:24 PM Eastern Daylight Time		07/01/2014 10:45:31 AM Eastern Daylight Time			07/03/2014 02:27:46 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	190	0	2015	Arkansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	191	0		29	10	S5967_191_0	4		1	05/29/2014	2015.02	05/29/2014 04:51:09 PM Eastern Daylight Time		06/02/2014 02:22:21 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	191	0	2015	Mississippi		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	192	0		29	10	S5967_192_0	4		1	05/29/2014	2015.02	05/29/2014 04:51:27 PM Eastern Daylight Time		06/02/2014 02:22:32 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	192	0	2015	Louisiana		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	193	0		29	10	S5967_193_0	4		1	05/29/2014	2015.02	05/29/2014 04:51:45 PM Eastern Daylight Time		06/02/2014 02:22:43 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	193	0	2015	Texas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	194	0		29	10	S5967_194_0	4		1	05/29/2014	2015.02	05/29/2014 04:52:03 PM Eastern Daylight Time		06/02/2014 02:22:54 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	194	0	2015	Oklahoma		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	195	0		29	10	S5967_195_0	4		1	05/29/2014	2015.02	05/29/2014 04:52:20 PM Eastern Daylight Time		06/02/2014 02:23:04 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	195	0	2015	Kansas		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	196	0		29	10	S5967_196_0	4		1	05/29/2014	2015.02	05/29/2014 04:52:37 PM Eastern Daylight Time		06/02/2014 02:23:15 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	196	0	2015	Upper Midwest and Northern Plains		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	197	0		29	10	S5967_197_0	4		1	05/29/2014	2015.02	05/29/2014 04:55:49 PM Eastern Daylight Time		06/02/2014 02:23:26 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	197	0	2015	New Mexico		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	198	0		29	10	S5967_198_0	4		1	05/29/2014	2015.02	05/29/2014 04:56:06 PM Eastern Daylight Time		06/02/2014 02:23:37 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	198	0	2015	Colorado		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	199	0		29	10	S5967_199_0	4		1	05/29/2014	2015.02	05/29/2014 04:56:23 PM Eastern Daylight Time		06/02/2014 02:23:47 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	199	0	2015	Arizona		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	200	0		29	10	S5967_200_0	4		1	05/29/2014	2015.02	05/29/2014 05:01:27 PM Eastern Daylight Time		06/02/2014 02:23:59 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	200	0	2015	Nevada		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	201	0		29	10	S5967_201_0	4		1	05/29/2014	2015.02	05/29/2014 05:01:45 PM Eastern Daylight Time		06/02/2014 02:24:09 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	201	0	2015	Oregon, Washington		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	202	0		29	10	S5967_202_0	4		1	05/29/2014	2015.02	05/29/2014 05:02:02 PM Eastern Daylight Time		06/02/2014 02:24:20 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	202	0	2015	Idaho, Utah		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	203	0		29	10	S5967_203_0	4		1	05/29/2014	2015.02	05/29/2014 05:02:20 PM Eastern Daylight Time		06/02/2014 02:24:31 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	203	0	2015	California		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	204	0		29	10	S5967_204_0	4		1	05/29/2014	2015.02	05/29/2014 05:02:59 PM Eastern Daylight Time		06/02/2014 02:24:41 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	204	0	2015	Hawaii		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	205	0		29	10	S5967_205_0	4		1	05/31/2014	2015.02	05/31/2014 10:14:32 AM Eastern Daylight Time		06/02/2014 02:24:52 PM Eastern Daylight Time			06/02/2014 03:45:33 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	WellCare Extra (PDP)	10	29					S5967	205	0	2015	Alaska		2					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	803	0		29	10	S5967_803_0	1		1	05/31/2014	2015.02	05/31/2014 08:37:07 PM Eastern Daylight Time					05/31/2014 11:54:32 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	PDP Employer Plan1 (PDP)	10	29					S5967	803	0	2015	National		1					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5967	804	0		29	10	S5967_804_0	1		1	05/31/2014	2015.02	05/31/2014 08:37:14 PM Eastern Daylight Time					05/31/2014 11:54:32 PM Eastern Daylight Time	WELLCARE PRESCRIPTION INSURANCE, INC.	WellCare	www.wellcarepdp.com	PDP Employer - Plan2 (PDP)	10	29					S5967	804	0	2015	National		1					2								www.wellcarepdp.com	www.wellcarepdp.com									(888)550-5252		(888)550-5252		(888)293-5151		(888)293-5151										(888)816-5252		(888)816-5252		(888)816-5252		(888)816-5252												
S5975	801	0		29	10	S5975_801_0	2		1	05/23/2014	2015.01	05/23/2014 10:53:47 AM Pacific Daylight Time					05/31/2014 02:36:29 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA HEALTH PLAN, INC.	www.modahealth.com/medicare	Moda Health Rx Employer Option (PDP)	10	29					S5975	801	0	2015	National		1					2								www.modahealth.com/medicare	www.modahealth.com/medicare									(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-												
S5975	805	0		29	10	S5975_805_0	2		1	05/23/2014	2015.01	05/23/2014 10:53:52 AM Pacific Daylight Time					05/31/2014 02:38:05 PM Pacific Daylight Time	MODA HEALTH PLAN, INC.	MODA HEALTH PLAN, INC.	www.modahealth.com/medicare	Moda Health Rx Employer Option (PDP)	10	29					S5975	805	0	2015	National		1					2								www.modahealth.com/medicare	www.modahealth.com/medicare									(888)786-7509		(503)265-4709		(888)217-2375		(503)265-2975										(711)-		(711)-		(711)-		(711)-												
S5983	004	0		29	10	S5983_004_0	2		1	06/01/2014	2015.01	06/01/2014 11:17:19 PM Eastern Daylight Time		07/17/2014 09:37:00 AM Eastern Daylight Time			07/18/2014 03:12:41 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Value (PDP)	10	29					S5983	004	0	2015	State of New York		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5983	006	0		29	10	S5983_006_0	1		1	05/31/2014	2015.01	05/31/2014 01:15:27 PM Eastern Daylight Time		06/01/2014 05:14:00 PM Eastern Daylight Time			06/02/2014 12:18:06 PM Eastern Daylight Time	MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare - Choice (PDP)	10	29					S5983	006	0	2015	State of New York		2					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(800)758-4570		(800)758-4570		(866)477-5704		(866)477-5704										(800)716-3231		(800)716-3231		(800)716-3231		(800)716-3231												
S5993	001	0		29	10	S5993_001_0	4		1	05/30/2014	2015.02	05/30/2014 03:20:20 PM Eastern Daylight Time		07/14/2014 09:41:42 AM Eastern Daylight Time			07/14/2014 10:37:49 AM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/medicare	Horizon Medicare Blue Rx Standard (PDP)	10	29					S5993	001	0	2015	New Jersey		2					2								http://www.horizonblue.com/pdp-drug-search	http://www.horizonblue.com/pdp-pharmacy-search									(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234										(711)-		(711)-		(800)852-7899		(800)852-7899												
S5993	003	0		29	10	S5993_003_0	3		1	06/02/2014	2015.02	06/02/2014 06:57:11 AM Eastern Daylight Time		07/14/2014 09:42:55 AM Eastern Daylight Time			07/14/2014 10:37:49 AM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com/medicare	Horizon Medicare Blue Rx Enhanced (PDP)	10	29					S5993	003	0	2015	New Jersey		2					2								http://www.horizonblue.com/pdp-drug-search	http://www.horizonblue.com/pdp-pharmacy-search									(800)391-1906		(800)391-1906		(800)224-1234		(800)224-1234										(711)-		(711)-		(800)852-7899		(800)852-7899												
S5993	801	0		29	10	S5993_801_0	1		1	05/20/2014	2015.02	05/20/2014 04:52:52 PM Eastern Daylight Time					05/21/2014 12:28:17 PM Eastern Daylight Time	HORIZON HEALTHCARE SERVICES, INC.	Horizon Blue Cross Blue Shield of New Jersey, Inc.	www.horizonblue.com	Horizon Medicare Blue Group Rx (PDP)	10	29					S5993	801	0	2015	National		1					2								medicare.horizonblue.com/medicare-part-D-prescription-drug-insurance-plans-new-jersey-formulary-sear	medicare.horizonblue.com/medicare-part-D-prescription-drug-insurance-plans-new-jersey-introduction									(800)391-1906		(800)391-1906		(888)328-4542		(888)328-4542										(711)-		(711)-		(800)852-7899		(800)852-7899												
S6506	001	0		29	10	S6506_001_0	4		1	05/30/2014	2015.01	05/30/2014 02:02:15 PM Central Daylight Time		05/31/2014 09:26:03 PM Central Daylight Time			06/01/2014 09:02:12 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Value (PDP)	10	29					S6506	001	0	2015	Arizona		2					2								www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com									(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-												
S6506	002	0		29	10	S6506_002_0	5		1	05/30/2014	2015.01	05/30/2014 02:03:45 PM Central Daylight Time		07/11/2014 01:52:59 PM Central Daylight Time			07/15/2014 09:24:02 AM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx Enhanced (PDP)	10	29					S6506	002	0	2015	Arizona		2					2								www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com									(877)853-7693		(877)853-7693		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-												
S6506	801	0		29	10	S6506_801_0	1		1	05/28/2014	2015.01	05/28/2014 12:57:39 PM Central Daylight Time					05/30/2014 01:10:00 PM Central Daylight Time	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Blue Cross and Blue Shield of Arizona	www.YourAZMedicareSolutions.com	Blue MedicareRx for Groups (PDP)	10	29					S6506	801	0	2015	Nationwide		1					2								www.YourAZMedicareSolutions.com	www.YourAZMedicareSolutions.com									(877)560-8058		(877)560-8058		(800)422-9990		(800)422-9990										(711)-		(711)-		(711)-		(711)-												
S6875	801	0		29	10	S6875_801_0	1		1	05/24/2014	2015.01	05/24/2014 10:49:22 AM Eastern Daylight Time					06/01/2014 01:07:34 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Select Option	http://www.ibxmedicare.com	Select Option Rx Group Option I CY (PDP)	10	29					S6875	801	0	2015	National		1					2							http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(866)456-1695		(866)456-1695										(711)-		(711)-		(711)-		(711)-												
S6875	802	0		29	10	S6875_802_0	1		1	05/24/2014	2015.01	05/24/2014 10:49:51 AM Eastern Daylight Time					06/01/2014 01:07:34 PM Eastern Daylight Time	QCC INSURANCE COMPANY	Select Option	http://www.ibxmedicare.com	Select Option Rx Group Option I Non-CY (PDP)	10	29					S6875	802	0	2015	National		1					2							http://www.ibxmedicare.com	http://www.ibxmedicare.com	http://www.ibxmedicare.com									(888)678-7009		(888)678-7009		(866)456-1695		(866)456-1695										(711)-		(711)-		(711)-		(711)-												
S7230	001	0		29	10	S7230_001_0	4		1	08/01/2014	2015.01	08/01/2014 09:59:31 AM Central Daylight Time		08/04/2014 10:02:54 AM Central Daylight Time			08/04/2014 10:04:26 AM Central Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7230	001	0	2015	State of Michigan		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-												
S7230	002	0		29	10	S7230_002_0	4		1	08/01/2014	2015.01	08/01/2014 09:59:41 AM Central Daylight Time		08/04/2014 10:03:00 AM Central Daylight Time			08/04/2014 10:04:26 AM Central Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7230	002	0	2015	State of Ohio		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-												
S7230	003	0		29	10	S7230_003_0	4		1	08/01/2014	2015.01	08/01/2014 09:59:52 AM Central Daylight Time		08/04/2014 10:03:00 AM Central Daylight Time			08/04/2014 10:04:26 AM Central Daylight Time	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7230	003	0	2015	States of Indiana and Kentucky		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-												
S7610	001	0		29	10	S7610_001_0	4		1	08/04/2014	2015.01	08/04/2014 08:59:59 AM Central Daylight Time		08/04/2014 10:03:01 AM Central Daylight Time			08/04/2014 10:04:26 AM Central Daylight Time	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Advantage-Plus Meridian	www.MedicareMeridian.com	Advantage-Plus Meridian (PDP)	10	29					S7610	001	0	2015	State of Illinois		2					2								www.MedicareMeridian.com	www.MedicareMeridian.com									(855)537-9756		(855)537-9756		(855)647-0075		(855)647-0075										(711)-		(711)-		(711)-		(711)-												
S7694	001	0		29	10	S7694_001_0	3		1	05/31/2014	2015.01	05/31/2014 03:43:53 PM Eastern Daylight Time		07/16/2014 11:14:21 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	001	0	2015	Northern New England Region 1 Silver - ME, NH		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	002	0		29	10	S7694_002_0	5		1	07/01/2014	2015.01	07/01/2014 10:19:23 AM Eastern Daylight Time		07/16/2014 11:18:01 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	002	0	2015	Central N England EnvisionRxPlusSilver-CT/MA/RI/VT		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	003	0		29	10	S7694_003_0	3		1	05/31/2014	2015.01	05/31/2014 03:48:01 PM Eastern Daylight Time		07/16/2014 11:20:20 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	003	0	2015	New York EnvsionRxPlus Silver Region 03		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	004	0		29	10	S7694_004_0	3		1	05/31/2014	2015.01	05/31/2014 03:49:01 PM Eastern Daylight Time		07/16/2014 11:24:34 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	004	0	2015	New Jersey EnvisionRxPlus Silver Region 04		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	005	0		29	10	S7694_005_0	3		1	05/31/2014	2015.01	05/31/2014 03:50:15 PM Eastern Daylight Time		07/16/2014 11:27:00 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	005	0	2015	Mid-Atlantic EnvisionRxPlusSilverRegion05-DE/DC/MD		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	006	0		29	10	S7694_006_0	3		1	05/31/2014	2015.01	05/31/2014 03:52:17 PM Eastern Daylight Time		07/16/2014 11:31:01 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	006	0	2015	Pennsylvania, WV,EnvisionRxPlus Silver Region 06		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	007	0		29	10	S7694_007_0	3		1	05/31/2014	2015.01	05/31/2014 08:37:21 PM Eastern Daylight Time		07/16/2014 11:31:46 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	007	0	2015	Virginia EnvisionRxPlus Silver Region 07		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	008	0		29	10	S7694_008_0	3		1	05/31/2014	2015.01	05/31/2014 03:56:25 PM Eastern Daylight Time		07/16/2014 11:30:13 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	008	0	2015	North Carolina EnvisionRxPlus Silver Region 08		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	009	0		29	10	S7694_009_0	3		1	05/31/2014	2015.01	05/31/2014 03:58:16 PM Eastern Daylight Time		07/16/2014 11:28:58 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	009	0	2015	South Carolina EnvsionRxPlus Silver Region 09		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	010	0		29	10	S7694_010_0	3		1	05/31/2014	2015.01	05/31/2014 03:59:40 PM Eastern Daylight Time		07/16/2014 11:27:54 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	010	0	2015	Georgia EnvisionRxPlus Silver Region 10		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	011	0		29	10	S7694_011_0	5		1	07/01/2014	2015.01	07/01/2014 10:20:44 AM Eastern Daylight Time		07/16/2014 11:26:40 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	011	0	2015	Florida EnvisionRxPlus Silver Region 11		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	012	0		29	10	S7694_012_0	3		1	05/31/2014	2015.01	05/31/2014 03:02:18 PM Eastern Daylight Time		07/16/2014 11:25:37 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	012	0	2015	Alabama,Tennessee EnvisionRxPlus Silver Region 12		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	014	0		29	10	S7694_014_0	3		1	05/31/2014	2015.01	05/31/2014 03:05:42 PM Eastern Daylight Time		07/16/2014 11:04:51 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	014	0	2015	Ohio EnvisionRxPlus Silver Region 14		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	015	0		29	10	S7694_015_0	3		1	05/31/2014	2015.01	05/31/2014 03:07:59 PM Eastern Daylight Time		07/16/2014 11:03:39 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	015	0	2015	Indiana, Kentucky EnvisionRxPlus Silver Region 15		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	016	0		29	10	S7694_016_0	3		1	05/31/2014	2015.01	05/31/2014 03:10:52 PM Eastern Daylight Time		07/16/2014 11:02:37 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	016	0	2015	Wisconsin EnvisionRxPlus Silver Region 16		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	017	0		29	10	S7694_017_0	3		1	05/31/2014	2015.01	05/31/2014 03:12:49 PM Eastern Daylight Time		07/16/2014 11:01:27 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	017	0	2015	Illinois EnvisionRxPlus Silver Region 17		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	018	0		29	10	S7694_018_0	3		1	05/31/2014	2015.01	05/31/2014 08:24:31 PM Eastern Daylight Time		07/16/2014 10:59:50 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	018	0	2015	Missouri EnvisionRxPlus Silver Region 18		2					2								EnvisionRxPlus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	019	0		29	10	S7694_019_0	3		1	05/31/2014	2015.01	05/31/2014 08:25:34 PM Eastern Daylight Time		07/16/2014 10:55:51 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	019	0	2015	Arkansas EnvisionRxPlus Silver Region 19		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	020	0		29	10	S7694_020_0	3		1	05/31/2014	2015.01	05/31/2014 03:20:04 PM Eastern Daylight Time		07/16/2014 10:54:47 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	020	0	2015	Mississippi EnvisionRxPlus Silver Region 20		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	021	0		29	10	S7694_021_0	3		1	05/31/2014	2015.01	05/31/2014 03:22:24 PM Eastern Daylight Time		07/16/2014 10:53:36 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	021	0	2015	Louisiana EnvisionRxPlus Silver Region 21		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	022	0		29	10	S7694_022_0	4		1	05/31/2014	2015.01	05/31/2014 03:24:28 PM Eastern Daylight Time		07/16/2014 10:52:14 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	022	0	2015	Texas EnvisionRxPlus Silver Region 22		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	023	0		29	10	S7694_023_0	3		1	06/01/2014	2015.01	06/01/2014 08:35:07 AM Eastern Daylight Time		07/16/2014 10:50:16 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	023	0	2015	Oklahoma EnvisionRxPlus Silver Region 23		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	024	0		29	10	S7694_024_0	3		1	05/31/2014	2015.01	05/31/2014 03:31:14 PM Eastern Daylight Time		07/16/2014 10:49:10 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	024	0	2015	Kansas EnvisionRxPlus Silver Region 24		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	025	0		29	10	S7694_025_0	3		1	05/31/2014	2015.01	05/31/2014 03:37:21 PM Eastern Daylight Time		07/16/2014 10:48:01 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	025	0	2015	Midwest EnvisionRxPlus Silver IA/NE/MN/MT/ND/SD/WY		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	026	0		29	10	S7694_026_0	3		1	05/31/2014	2015.01	05/31/2014 03:39:28 PM Eastern Daylight Time		07/16/2014 10:46:57 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	026	0	2015	New Mexico EnvisionRxPlus Silver Region 26		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	027	0		29	10	S7694_027_0	3		1	05/31/2014	2015.01	05/31/2014 03:43:25 PM Eastern Daylight Time		07/16/2014 10:45:52 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	027	0	2015	Colorado EnvisionRxPlus Silver Region 27		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	028	0		29	10	S7694_028_0	3		1	05/31/2014	2015.01	05/31/2014 03:45:05 PM Eastern Daylight Time		07/16/2014 10:44:47 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	028	0	2015	Arizona EnvisionRxPlus Silver Region 28		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	029	0		29	10	S7694_029_0	4		1	07/01/2014	2015.01	07/01/2014 10:22:35 AM Eastern Daylight Time		07/16/2014 10:43:36 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	029	0	2015	Nevada EnvisionRxPlus Silver Region 29		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	030	0		29	10	S7694_030_0	3		1	05/31/2014	2015.01	05/31/2014 03:50:04 PM Eastern Daylight Time		07/16/2014 10:42:09 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	030	0	2015	Oregon, Washington EnvisionRxPlus Silver Region 30		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	031	0		29	10	S7694_031_0	3		1	05/31/2014	2015.01	05/31/2014 08:29:37 PM Eastern Daylight Time		07/16/2014 10:40:59 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	031	0	2015	Idaho, Utah EnvisionRxPlus Silver Region 31		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	032	0		29	10	S7694_032_0	4		1	05/31/2014	2015.01	05/31/2014 04:01:15 PM Eastern Daylight Time		07/16/2014 10:39:52 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	032	0	2015	California EnvisionRxPlus Silver Region 32		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	033	0		29	10	S7694_033_0	3		1	05/31/2014	2015.01	05/31/2014 04:04:07 PM Eastern Daylight Time		07/16/2014 10:35:46 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	033	0	2015	Hawaii EnvisionRxPlus Silver Region 33		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	034	0		29	10	S7694_034_0	4		1	05/31/2014	2015.01	05/31/2014 04:13:56 PM Eastern Daylight Time		07/18/2014 11:19:44 AM Eastern Daylight Time			07/21/2014 11:54:30 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	034	0	2015	Alaska EnvisionRxPlus Silver Region 34		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	070	0		29	10	S7694_070_0	3		1	05/31/2014	2015.01	05/31/2014 04:13:31 PM Eastern Daylight Time		07/16/2014 10:32:25 AM Eastern Daylight Time			07/18/2014 11:55:42 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	070	0	2015	Michigan Region 13		2					2							EnvisionRxPlus.com	EnvisionRxPlus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	105	0		29	10	S7694_105_0	1		1	05/31/2014	2015.01	05/31/2014 08:21:33 PM Eastern Daylight Time		06/01/2014 11:22:09 AM Eastern Daylight Time			06/01/2014 04:54:04 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	105	0	2015	Puerto Rico (Region 38) Silver		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	106	0		29	10	S7694_106_0	2		1	05/31/2014	2015.01	05/31/2014 08:19:13 PM Eastern Daylight Time		07/18/2014 01:02:59 PM Eastern Daylight Time			07/21/2014 11:54:30 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Silver (PDP)	10	29					S7694	106	0	2015	Guam (Region 36) Silver Plan		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	107	0		29	10	S7694_107_0	1		1	05/30/2014	2015.01	05/30/2014 04:45:26 PM Eastern Daylight Time		05/31/2014 12:42:16 PM Eastern Daylight Time			06/01/2014 10:22:52 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Clear Choice (PDP)	10	29					S7694	107	0	2015	Region 9 SC Envision Clear Choice (PBP 107)		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	111	0		29	10	S7694_111_0	1		1	05/30/2014	2015.01	05/30/2014 04:51:57 PM Eastern Daylight Time		05/31/2014 12:42:46 PM Eastern Daylight Time			06/01/2014 10:22:52 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRxPlus Clear Choice (PDP)	10	29					S7694	111	0	2015	Region 17 IL EnvisionRxPlus Clear Choice (PBP 111)		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	112	0		29	10	S7694_112_0	1		1	05/30/2014	2015.01	05/30/2014 04:51:57 PM Eastern Daylight Time		05/31/2014 12:43:17 PM Eastern Daylight Time			06/01/2014 10:22:52 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	112	0	2015	Reg 22 Texas EnvisionRxPlus Clear Choice (PBP 112)		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	113	0		29	10	S7694_113_0	1		1	05/30/2014	2015.01	05/30/2014 04:51:57 PM Eastern Daylight Time		05/31/2014 12:43:51 PM Eastern Daylight Time			06/01/2014 10:22:52 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	113	0	2015	Reg 26 New Mexico EnvisionRx Clear Choice (PBP113)		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	114	0		29	10	S7694_114_0	1		1	05/30/2014	2015.01	05/30/2014 04:51:58 PM Eastern Daylight Time		05/31/2014 12:44:17 PM Eastern Daylight Time			06/01/2014 10:22:52 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	114	0	2015	Reg 28 Arizona EnvisionRxPlus Clear Choice  PBP114		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	115	0		29	10	S7694_115_0	1		1	05/30/2014	2015.01	05/30/2014 04:51:58 PM Eastern Daylight Time		05/31/2014 12:44:35 PM Eastern Daylight Time			06/01/2014 10:22:52 AM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	www.envisionrxplus.com	EnvisionRx Plus Clear Choice (PDP)	10	29					S7694	115	0	2015	Reg 30 OR/WA EnvisionRxPlus Clear Choice PBP115		2					2							www.envisionrxplus.com	www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	801	0		29	10	S7694_801_0	2		1	06/01/2014	2015.01	06/01/2014 07:24:37 PM Eastern Daylight Time					06/01/2014 07:25:19 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Plan Calendar Year (PDP)	10	29					S7694	801	0	2015	National EGWP		1					2								www.envisionrxplus.com	www.envisionrxplus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7694	802	0		29	10	S7694_802_0	2		1	06/01/2014	2015.01	06/01/2014 07:24:52 PM Eastern Daylight Time					06/01/2014 07:25:19 PM Eastern Daylight Time	ENVISION INSURANCE COMPANY	EnvisionRx Plus	EnvisionRxPlus.com	Employer Group Non-Calendar Year (PDP)	10	29					S7694	802	0	2015	National EGWP		1					2								www.envisionrxplus.com	EnvisionRxPlus.com									(866)250-2005		(866)250-2005		(866)250-2005		(866)250-2005										(711)-		(711)-		(711)-		(711)-												
S7950	801	0		29	10	S7950_801_0	1		1	06/02/2014	2015.01	06/02/2014 01:11:50 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	801	0	2015	High Performance 4 Teir		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	802	0		29	10	S7950_802_0	1		1	06/02/2014	2015.01	06/02/2014 01:11:56 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	802	0	2015	National Preferred 4 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	803	0		29	10	S7950_803_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:01 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	803	0	2015	4 Tier Transition		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	804	0		29	10	S7950_804_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:08 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	804	0	2015	High Performance 4 Tier Non Calendar		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	805	0		29	10	S7950_805_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:16 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	805	0	2015	High Performance 1 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	806	0		29	10	S7950_806_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:19 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	806	0	2015	High Performance Open		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	807	0		29	10	S7950_807_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:25 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.express-scriptsmedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	807	0	2015	National Preferred 5 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	808	0		29	10	S7950_808_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:29 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	808	0	2015	5 Tier Transition		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S7950	809	0		29	10	S7950_809_0	1		1	06/02/2014	2015.01	06/02/2014 01:12:34 PM Eastern Daylight Time					06/02/2014 01:14:13 PM Eastern Daylight Time	EXPRESS SCRIPTS INSURANCE CO.	Express Scripts Medicare	www.Express-ScriptsMedicare.com	Express Scripts Medicare (PDP)	10	29					S7950	809	0	2015	High Performance 3 Tier		1					2								www.Express-ScriptsMedicare.com	www.Express-ScriptsMedicare.com									(888)345-2560		(888)345-2560		(888)345-2560		(888)345-2560										(800)899-2114		(800)899-2114		(800)899-2114		(800)899-2114												
S8067	001	0		29	10	S8067_001_0	4		1	05/31/2014	2015.01	05/31/2014 08:51:40 PM Eastern Daylight Time		05/31/2014 04:31:08 PM Eastern Daylight Time			06/02/2014 08:32:46 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.securerxpdp.com	SecureRx - Option 3 (PDP)	10	29					S8067	001	0	2015	Region 6 - Pennsylvania, West Virginia		2					2								https://www.securerxpdp.com/DrugFormularies/	https://www.securerxpdp.com/									(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961												
S8067	003	0		29	10	S8067_003_0	4		1	05/31/2014	2015.01	05/31/2014 08:51:55 PM Eastern Daylight Time		05/31/2014 04:31:38 PM Eastern Daylight Time			06/02/2014 08:32:46 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.securerxpdp.com	SecureRx - Option 1 (PDP)	10	29					S8067	003	0	2015	Region 06 - Pennsylvania and West Virginia		2					2								https://www.securerxpdp.com/DrugFormularies/	https://www.securerxpdp.com/									(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961												
S8067	801	0		29	10	S8067_801_0	4		1	06/02/2014	2015.01	06/02/2014 06:48:23 PM Eastern Daylight Time					06/02/2014 08:32:46 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.securerxpdp.com	SecureRx - ER (PDP)	10	29					S8067	801	0	2015	National		1					2								https://www.securerxpdp.com/DrugFormularies/	https://www.securerxpdp.com/									(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961												
S8067	802	0		29	10	S8067_802_0	4		1	06/02/2014	2015.01	06/02/2014 06:48:32 PM Eastern Daylight Time					06/02/2014 08:32:46 PM Eastern Daylight Time	AVALON INSURANCE COMPANY	Avalon Insurance Company	www.securerxpdp.com	SecureRx - ER - Non-Calendar PY (PDP)	10	29					S8067	802	0	2015	National		1					2								https://www.securerxpdp.com/DrugFormularies/	https://www.securerxpdp.com/									(877)234-3853		(877)234-3853		(888)839-7330		(888)839-7330										(800)779-6961		(800)779-6961		(800)779-6961		(800)779-6961												
S8841	803	0		29	10	S8841_803_0	1		1	05/30/2014	2015.01	05/30/2014 02:37:58 PM Eastern Daylight Time					05/30/2014 02:41:22 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2015 EGWP 4-Tier Formulary CY Plan (PDP)	10	29					S8841	803	0	2015	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.com									(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-												
S8841	804	0		29	10	S8841_804_0	2		1	05/30/2014	2015.01	05/30/2014 02:38:29 PM Eastern Daylight Time					05/30/2014 03:21:35 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2015 EGWP 4-Tier Formulary NCY Plan (PDP)	10	29					S8841	804	0	2015	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.com									(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-												
S8841	807	0		29	10	S8841_807_0	2		1	05/30/2014	2015.01	05/30/2014 02:39:11 PM Eastern Daylight Time					05/30/2014 03:21:35 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2015 EGWP 5-Tier Formulary CY Plan (PDP)	10	29					S8841	807	0	2015	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.com									(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-												
S8841	808	0		29	10	S8841_808_0	2		1	05/30/2014	2015.01	05/30/2014 02:40:09 PM Eastern Daylight Time					05/30/2014 03:21:35 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2015 EGWP 5-Tier Formulary NCY Plan (PDP)	10	29					S8841	808	0	2015	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.com									(866)443-1095		(866)443-1095		(866)443-1095		(866)443-1095										(711)-		(711)-		(711)-		(711)-												
S8841	810	0		29	10	S8841_810_0	2		1	05/30/2014	2015.01	05/30/2014 02:40:52 PM Eastern Daylight Time					05/30/2014 03:21:35 PM Eastern Daylight Time	CATAMARAN INSURANCE OF OHIO, INC.	Catamaran Insurance of Ohio, Inc.	www.catamaranRx.com	2015 MPSERS Plan (PDP)	10	29					S8841	810	0	2015	National		1					2								www.mycatamaranrx.com	www.mycatamaranrx.com									(855)577-6517		(855)577-6517		(855)577-6517		(855)577-6517										(711)-		(711)-		(711)-		(711)-												
S9579	001	0		29	10	S9579_001_0	1		1	05/28/2014	2015.01	05/28/2014 08:35:31 PM Eastern Daylight Time		05/28/2014 10:10:48 PM Eastern Daylight Time			05/29/2014 11:28:02 AM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	001	0	2015	New Hampshire and Maine		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	002	0		29	10	S9579_002_0	1		1	05/29/2014	2015.01	05/29/2014 04:26:18 PM Eastern Daylight Time		05/28/2014 10:11:10 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	002	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	003	0		29	10	S9579_003_0	1		1	05/28/2014	2015.01	05/28/2014 08:36:03 PM Eastern Daylight Time		05/28/2014 10:11:30 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	003	0	2015	New Jersey		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	004	0		29	10	S9579_004_0	1		1	05/29/2014	2015.01	05/29/2014 04:39:55 PM Eastern Daylight Time		05/28/2014 10:11:52 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	004	0	2015	Delaware, District of Columbia and Maryland		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	005	0		29	10	S9579_005_0	1		1	05/28/2014	2015.01	05/28/2014 08:36:31 PM Eastern Daylight Time		05/28/2014 10:12:10 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	005	0	2015	Pennsylvania and West Virginia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	006	0		29	10	S9579_006_0	1		1	05/28/2014	2015.01	05/28/2014 08:36:50 PM Eastern Daylight Time		05/28/2014 10:12:26 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	006	0	2015	Virginia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	007	0		29	10	S9579_007_0	1		1	05/28/2014	2015.01	05/28/2014 08:36:58 PM Eastern Daylight Time		05/28/2014 10:12:44 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	007	0	2015	North Carolina		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	008	0		29	10	S9579_008_0	1		1	05/28/2014	2015.01	05/28/2014 08:37:08 PM Eastern Daylight Time		05/28/2014 10:13:04 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	008	0	2015	South Carolina		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	009	0		29	10	S9579_009_0	1		1	05/28/2014	2015.01	05/28/2014 08:37:18 PM Eastern Daylight Time		05/28/2014 10:13:40 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	009	0	2015	Georgia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	010	0		29	10	S9579_010_0	1		1	05/28/2014	2015.01	05/28/2014 08:37:26 PM Eastern Daylight Time		05/28/2014 10:14:06 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	010	0	2015	Florida		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	011	0		29	10	S9579_011_0	1		1	05/28/2014	2015.01	05/28/2014 08:37:36 PM Eastern Daylight Time		05/28/2014 10:14:22 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	011	0	2015	Alabama and Tennesee		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	012	0		29	10	S9579_012_0	1		1	05/28/2014	2015.01	05/28/2014 08:37:58 PM Eastern Daylight Time		05/28/2014 10:14:42 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	012	0	2015	Michigan		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	013	0		29	10	S9579_013_0	1		1	05/28/2014	2015.01	05/28/2014 08:38:09 PM Eastern Daylight Time		05/28/2014 10:15:00 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	013	0	2015	Ohio		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	014	0		29	10	S9579_014_0	1		1	05/28/2014	2015.01	05/28/2014 08:40:44 PM Eastern Daylight Time		05/28/2014 10:15:18 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	014	0	2015	Indiana and Kentucky		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	015	0		29	10	S9579_015_0	1		1	05/28/2014	2015.01	05/28/2014 08:40:54 PM Eastern Daylight Time		05/28/2014 10:15:38 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	015	0	2015	Wisconsin		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	016	0		29	10	S9579_016_0	1		1	05/28/2014	2015.01	05/28/2014 08:41:03 PM Eastern Daylight Time		05/28/2014 10:15:56 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	016	0	2015	Illinois		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	017	0		29	10	S9579_017_0	1		1	05/28/2014	2015.01	05/28/2014 08:41:22 PM Eastern Daylight Time		05/28/2014 10:16:14 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	017	0	2015	Missouri		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	018	0		29	10	S9579_018_0	1		1	05/28/2014	2015.01	05/28/2014 08:41:35 PM Eastern Daylight Time		05/28/2014 10:16:34 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	018	0	2015	Arkansas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	019	0		29	10	S9579_019_0	1		1	05/28/2014	2015.01	05/28/2014 08:41:45 PM Eastern Daylight Time		05/28/2014 10:16:52 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	019	0	2015	Mississippi		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	020	0		29	10	S9579_020_0	1		1	05/28/2014	2015.01	05/28/2014 08:41:54 PM Eastern Daylight Time		05/28/2014 10:17:10 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	020	0	2015	Louisiana		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	021	0		29	10	S9579_021_0	1		1	05/28/2014	2015.01	05/28/2014 08:42:02 PM Eastern Daylight Time		05/28/2014 10:17:28 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	021	0	2015	Texas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	022	0		29	10	S9579_022_0	1		1	05/28/2014	2015.01	05/28/2014 08:42:11 PM Eastern Daylight Time		05/28/2014 10:17:48 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	022	0	2015	Oklahoma		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	023	0		29	10	S9579_023_0	1		1	05/28/2014	2015.01	05/28/2014 08:42:31 PM Eastern Daylight Time		05/28/2014 10:18:06 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	023	0	2015	Kansas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	024	0		29	10	S9579_024_0	1		1	05/28/2014	2015.01	05/28/2014 08:42:39 PM Eastern Daylight Time		05/28/2014 10:18:26 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	024	0	2015	IA, MN, MT, ND, NE, SD, WY		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	025	0		29	10	S9579_025_0	1		1	05/28/2014	2015.01	05/28/2014 08:42:48 PM Eastern Daylight Time		05/28/2014 10:18:44 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	025	0	2015	New Mexico		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	026	0		29	10	S9579_026_0	1		1	05/28/2014	2015.01	05/28/2014 08:43:10 PM Eastern Daylight Time		05/28/2014 10:19:02 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	026	0	2015	Colorado		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	027	0		29	10	S9579_027_0	1		1	05/28/2014	2015.01	05/28/2014 08:43:19 PM Eastern Daylight Time		05/28/2014 10:19:22 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	027	0	2015	Arizona		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	028	0		29	10	S9579_028_0	1		1	05/28/2014	2015.01	05/28/2014 08:43:36 PM Eastern Daylight Time		05/28/2014 10:19:42 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	028	0	2015	Nevada		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	029	0		29	10	S9579_029_0	1		1	05/28/2014	2015.01	05/28/2014 08:43:47 PM Eastern Daylight Time		05/28/2014 10:20:00 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	029	0	2015	Oregon and Washington		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	030	0		29	10	S9579_030_0	1		1	05/28/2014	2015.01	05/28/2014 08:43:57 PM Eastern Daylight Time		05/28/2014 10:20:20 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	030	0	2015	Idaho and Utah		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	031	0		29	10	S9579_031_0	1		1	05/28/2014	2015.01	05/28/2014 08:44:06 PM Eastern Daylight Time		05/28/2014 10:20:38 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	031	0	2015	California		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	032	0		29	10	S9579_032_0	1		1	05/28/2014	2015.01	05/28/2014 08:44:16 PM Eastern Daylight Time		05/28/2014 10:20:58 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	032	0	2015	Hawaii		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	033	0		29	10	S9579_033_0	1		1	05/28/2014	2015.01	05/28/2014 08:44:24 PM Eastern Daylight Time		05/28/2014 10:21:16 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Classic (PDP)	10	29					S9579	033	0	2015	Alaska		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	034	0		29	10	S9579_034_0	1		1	05/28/2014	2015.01	05/28/2014 08:50:58 PM Eastern Daylight Time		05/28/2014 10:21:34 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	034	0	2015	New Hampshire and Maine		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	035	0		29	10	S9579_035_0	1		1	05/28/2014	2015.01	05/28/2014 08:51:10 PM Eastern Daylight Time		05/28/2014 10:21:56 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	035	0	2015	Connecticut, Massachusetts, Rhode Island, Vermont		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	036	0		29	10	S9579_036_0	1		1	05/28/2014	2015.01	05/28/2014 08:51:22 PM Eastern Daylight Time		05/28/2014 10:22:16 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	036	0	2015	New Jersey		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	037	0		29	10	S9579_037_0	1		1	05/28/2014	2015.01	05/28/2014 08:51:32 PM Eastern Daylight Time		05/28/2014 10:22:38 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	037	0	2015	Delaware, District of Columbia and Maryland		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	038	0		29	10	S9579_038_0	1		1	05/28/2014	2015.01	05/28/2014 08:51:43 PM Eastern Daylight Time		05/28/2014 10:22:58 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	038	0	2015	Pennsylvania and West Virginia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	039	0		29	10	S9579_039_0	1		1	05/28/2014	2015.01	05/28/2014 08:51:52 PM Eastern Daylight Time		05/28/2014 10:23:18 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	039	0	2015	Virginia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	040	0		29	10	S9579_040_0	1		1	05/29/2014	2015.01	05/29/2014 11:13:52 AM Eastern Daylight Time		05/28/2014 10:23:40 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	040	0	2015	North Carolina		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	041	0		29	10	S9579_041_0	1		1	05/29/2014	2015.01	05/29/2014 11:14:24 AM Eastern Daylight Time		05/28/2014 10:24:00 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	041	0	2015	South Carolina		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	042	0		29	10	S9579_042_0	1		1	05/29/2014	2015.01	05/29/2014 11:14:34 AM Eastern Daylight Time		05/28/2014 10:24:22 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	042	0	2015	Georgia		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	043	0		29	10	S9579_043_0	1		1	05/29/2014	2015.01	05/29/2014 11:14:43 AM Eastern Daylight Time		05/28/2014 10:24:44 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	043	0	2015	Florida		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	044	0		29	10	S9579_044_0	1		1	05/29/2014	2015.01	05/29/2014 11:14:52 AM Eastern Daylight Time		05/28/2014 10:25:06 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	044	0	2015	Alabama and Tennessee		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	045	0		29	10	S9579_045_0	1		1	05/29/2014	2015.01	05/29/2014 11:15:07 AM Eastern Daylight Time		05/28/2014 10:25:28 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	045	0	2015	Michigan		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	046	0		29	10	S9579_046_0	1		1	05/29/2014	2015.01	05/29/2014 11:15:19 AM Eastern Daylight Time		05/28/2014 10:25:48 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	046	0	2015	Ohio		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	047	0		29	10	S9579_047_0	1		1	05/29/2014	2015.01	05/29/2014 11:15:28 AM Eastern Daylight Time		05/28/2014 10:26:06 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	047	0	2015	Indiana and Kentucky		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	048	0		29	10	S9579_048_0	1		1	05/29/2014	2015.01	05/29/2014 11:15:45 AM Eastern Daylight Time		05/28/2014 10:26:20 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	048	0	2015	Wisconsin		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	049	0		29	10	S9579_049_0	1		1	05/29/2014	2015.01	05/29/2014 01:42:26 PM Eastern Daylight Time		05/28/2014 10:26:36 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	049	0	2015	Illinois		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	050	0		29	10	S9579_050_0	1		1	05/29/2014	2015.01	05/29/2014 01:42:35 PM Eastern Daylight Time		05/28/2014 10:26:54 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	050	0	2015	Missouri		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	051	0		29	10	S9579_051_0	1		1	05/29/2014	2015.01	05/29/2014 01:43:52 PM Eastern Daylight Time		05/28/2014 10:27:10 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	051	0	2015	Arkansas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	052	0		29	10	S9579_052_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:03 PM Eastern Daylight Time		05/28/2014 10:27:26 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	052	0	2015	Mississippi		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	053	0		29	10	S9579_053_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:12 PM Eastern Daylight Time		05/28/2014 10:27:44 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	053	0	2015	Louisiana		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	054	0		29	10	S9579_054_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:21 PM Eastern Daylight Time		05/28/2014 10:28:00 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	054	0	2015	Texas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	055	0		29	10	S9579_055_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:29 PM Eastern Daylight Time		05/28/2014 10:28:18 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	055	0	2015	Oklahoma		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	056	0		29	10	S9579_056_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:38 PM Eastern Daylight Time		05/28/2014 10:28:36 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	056	0	2015	Kansas		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	057	0		29	10	S9579_057_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:48 PM Eastern Daylight Time		05/28/2014 10:28:54 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	057	0	2015	IA, MN, MT, ND, NE, SD, WY		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	058	0		29	10	S9579_058_0	1		1	05/29/2014	2015.01	05/29/2014 01:44:56 PM Eastern Daylight Time		05/28/2014 10:29:12 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	058	0	2015	New Mexico		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	059	0		29	10	S9579_059_0	1		1	05/29/2014	2015.01	05/29/2014 01:45:06 PM Eastern Daylight Time		05/28/2014 10:29:30 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	059	0	2015	Colorado		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	060	0		29	10	S9579_060_0	1		1	05/29/2014	2015.01	05/29/2014 01:45:16 PM Eastern Daylight Time		05/28/2014 10:29:52 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	060	0	2015	Arizona		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	061	0		29	10	S9579_061_0	1		1	05/29/2014	2015.01	05/29/2014 01:45:26 PM Eastern Daylight Time		05/28/2014 10:30:08 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	061	0	2015	Nevada		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	062	0		29	10	S9579_062_0	1		1	05/29/2014	2015.01	05/29/2014 01:45:35 PM Eastern Daylight Time		05/28/2014 10:30:26 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	062	0	2015	Oregon and Washington		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	063	0		29	10	S9579_063_0	1		1	05/29/2014	2015.01	05/29/2014 01:45:46 PM Eastern Daylight Time		05/28/2014 10:30:44 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	063	0	2015	Idaho and Utah		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	064	0		29	10	S9579_064_0	1		1	05/29/2014	2015.01	05/29/2014 01:45:57 PM Eastern Daylight Time		05/28/2014 10:31:04 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	064	0	2015	California		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	065	0		29	10	S9579_065_0	1		1	05/29/2014	2015.01	05/29/2014 01:46:09 PM Eastern Daylight Time		05/28/2014 10:31:22 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	065	0	2015	Hawaii		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	066	0		29	10	S9579_066_0	1		1	05/29/2014	2015.01	05/29/2014 01:46:19 PM Eastern Daylight Time		05/28/2014 10:31:40 PM Eastern Daylight Time			05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.transamericamedicarerx.com	Transamerica MedicareRx Choice (PDP)	10	29					S9579	066	0	2015	Alaska		2					2								www.transamericamedicarerx.com	www.transamericamedicarerx.com									(888)672-7206		(888)672-7206		(877)527-1958		(877)527-1958										(711)-		(711)-		(711)-		(711)-												
S9579	803	0		29	10	S9579_803_0	1		1	05/29/2014	2015.01	05/29/2014 04:26:35 PM Eastern Daylight Time					05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	803	0	2015	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-												
S9579	804	0		29	10	S9579_804_0	1		1	05/29/2014	2015.01	05/29/2014 04:26:30 PM Eastern Daylight Time					05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	804	0	2015	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-												
S9579	805	0		29	10	S9579_805_0	1		1	05/29/2014	2015.01	05/29/2014 04:26:26 PM Eastern Daylight Time					05/29/2014 06:41:24 PM Eastern Daylight Time	STONEBRIDGE LIFE INSURANCE COMPANY	Stonebridge Life Insurance Company	www.medicaregenerationrx.com	Medicare GenerationRx (PDP)	10	29					S9579	805	0	2015	Medicare GenerationRx		1					2								www.medicaregenerationrx.com	www.medicaregenerationrx.com									(877)633-7943		(877)633-7943		(877)633-7943		(877)633-7943										(711)-		(711)-		(711)-		(711)-												
S9701	801	0		29	10	S9701_801_0	1		1	05/29/2014	2015.01	05/29/2014 03:18:14 PM Central Daylight Time					05/29/2014 03:20:55 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	801	0	2015	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-												
S9701	802	0		29	10	S9701_802_0	2		1	05/20/2014	2015.01	05/20/2014 04:37:03 PM Central Daylight Time					05/29/2014 03:40:01 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	802	0	2015	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-												
S9701	803	0		29	10	S9701_803_0	2		1	05/20/2014	2015.01	05/20/2014 04:37:20 PM Central Daylight Time					05/29/2014 03:40:01 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	803	0	2015	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-												
S9701	804	0		29	10	S9701_804_0	2		1	05/20/2014	2015.01	05/20/2014 04:37:35 PM Central Daylight Time					05/29/2014 03:40:01 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	804	0	2015	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-												
S9701	805	0		29	10	S9701_805_0	2		1	05/20/2014	2015.01	05/20/2014 04:37:50 PM Central Daylight Time					05/29/2014 03:40:01 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	805	0	2015	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-												
S9701	806	0		29	10	S9701_806_0	2		1	05/20/2014	2015.01	05/20/2014 04:38:03 PM Central Daylight Time					05/29/2014 03:40:01 PM Central Daylight Time	DEAN HEALTH INSURANCE, INC.	Navitus MedicareRx	https://medicarerx.navitus.com/	Navitus MedicareRx (PDP)	10	29					S9701	806	0	2015	Navitus MedicareRx		1					2								https://medicarerx.navitus.com/	https://medicarerx.navitus.com/									(866)270-3877		(866)270-3877		(866)270-3877		(866)270-3877										(711)-		(711)-		(711)-		(711)-												
